# Psychometric validation of the Physician Well-Being Index-Expanded (ePWBI) among physician educators in Hong Kong

## TL;DR

This study validates a tool for measuring stress and well-being among physician educators in Hong Kong, showing it works well and can help identify those needing support.

## Contribution

The study confirms the ePWBI's validity in an Asian context, expanding its cross-cultural applicability for assessing physician educators' well-being.

## Key findings

- The ePWBI demonstrated strong construct validity with good fit indices in Hong Kong physician educators.
- Younger physician educators (20–39 years) reported higher distress levels compared to older groups.
- The ePWBI showed acceptable internal consistency and discriminant validity when compared to the WHO-5.

## Abstract

Physician educators’ distress and well-being are of emerging concern in academic medicine. The Physician Well-Being Index-Expanded (ePWBI) is known for measuring physician distress and well-being, yet its psychometric properties in Asian contexts, including Hong Kong (HK), remain unexamined. This study evaluated the reliability and validity of the ePWBI in determining the distress and well-being of HK physician educators.

This cross-sectional validation study recruited 333 physician educators using convenience sampling at a HK medical school from October 2020 to January 2021, during the COVID-19 pandemic. Participants voluntarily completed the 9-item ePWBI and 5-item World Health Organization Well-Being Index (WHO-5) instruments in an online survey. Psychometric validation included within-network analyses (confirmatory factor analysis [CFA], one-way ANOVA, independent t-tests), and between-network analyses (ROC curves and correlational analyses with the WHO-5).

Using data from 333 physician educators, the ePWBI demonstrated excellent construct validity. CFA results indicated good data fit to the a priori model: Comparative Fit Index=0.99, Tucker–Lewis Index=0.99, Standardized Root Mean Square Residual=0.05, and Root Mean Square Error of Approximation=0.02 [90% CI 0.00–0.05]. Most factor loadings ranged from 0.36 to 0.69 and were statistically significant (p<0.05). Significant age differences in distress levels were found [F(4,328)=5.39, p<0.001], with younger educators (aged 20–39) experiencing greater distress. However, no gender differences were observed [t(328)=−1.16, p=0.247]. Between-network analyses revealed significant correlations between the ePWBI and WHO-5 scores (−0.09 to −0.42), along with satisfactory ROC results, indicating acceptable internal consistency and good discriminatory power.

The ePWBI appears to be a valid and reliable instrument for assessing the distress and well-being of HK physician educators. It shows promise as a tool for identifying those at higher risk of distress who could benefit from early tailored interventions and in practice, it could thereby strengthen mental health support systems in academic medical institutions.

The ePWBI showed strong construct validity, while internal consistency and discriminant validity when compared to the WHO-5 were both acceptable, supporting its use in assessing distress and well-being among Hong Kong physician educators.Younger physician educators (20–39 years old) reported higher distress, suggesting early-career professionals may benefit from tailored institutional support.The study extends the use of the ePWBI to an Asian context, advancing its applicability across cultures. Its brevity plus psychometric strength make it a practical tool for monitoring physician educator distress and well-being.

The ePWBI showed strong construct validity, while internal consistency and discriminant validity when compared to the WHO-5 were both acceptable, supporting its use in assessing distress and well-being among Hong Kong physician educators.

Younger physician educators (20–39 years old) reported higher distress, suggesting early-career professionals may benefit from tailored institutional support.

The study extends the use of the ePWBI to an Asian context, advancing its applicability across cultures. Its brevity plus psychometric strength make it a practical tool for monitoring physician educator distress and well-being.