Cultural Adaptation of the Wellness Evaluation of Lifestyle : An Assessment Challenge

The Wellness Evaluation of Lifestyle (WEL), developed in English, was translated into Korean, field tested, then administered to Korean American adolescents. Means were similar for participants completing the scale in both languages. Challenges to the adaptation process, recommendations for further study of the Korean WEL, and implications for cross-cultural wellness research are discussed. Article: As the population of the United States diversifies, the need to include and study ethnic minority individuals increases (Prieto, 1992). This is especially true for the Korean American population, one of the fastest growing ethnic groups. In 1990, there were approximately 800,000 Korean Americans living in the United States (U.S. Department of Commerce, 1995). The official 2000 census count included 1,076,872 Korean Americans, a number that does not include Korean Americans who selected multiple races rather than a single ethnic identity (U.S. Census Bureau, 2000). The recency of this growth in the Korean population suggests that Korean Americans are primarily a firstand second-generation immigrant group, and, thus, research on Koreans in the United States is still in the exploratory stage. As a consequence of the recency of immigration, young Koreans, especially adolescents, are primarily bicultural and are faced with the dual expectations of becoming acculturated to dominant American cultural values while also maintaining traditional Korean cultural values emphasizing family and community ties (Chang, 1998; Jung, 2001; B. S. K. Kim. Omizo, & Salvador, 1996). During adolescence it is common for conflict and disagreements with parents and other authority figures to increase and for peer influence to become more important than that of one's family (Flannery, Montemayor, Eberly, & Torquati, 1993). For the majority of adolescents, a positive response from peers results in feelings or acceptance and belonging, whereas the absence of peer acceptance can lead to feelings of isolation (Vernon, 1999). For ethnic minority youth, conflict and decreased closeness with parents combined with prejudice and racial bias create the dual risk of alienation from their peers and feelings of social isolation from their family and community as well (Phinney & Rosenthal, 1992; Smith, 1985). Vernon noted that virtually all children experience a variety of social and environmental stressors that may affect their overall well-being or wellness; ethnic minority adolescents, including Korean Americans, are significantly more at risk (Ghuman, 1991; Huang, 1994 ). Following the traditional medical model, most research on Korean Americans has focused on behavioral and emotional problems (Jung, 2001), clinical syndromes such as abuse and neglect (W. J. Kim, Kim, & Rue, 1997), and a variety of specific challenges to mental health (Toarmino & Chun, 1997). A few recent studies have addressed distress and coping behaviors (Bjorck, Cuthbertson, Thurman, & Lee, 2001; Bjorck, Lee, & Cohen, 1997; Mui, 2001; Yeh & Wang, 2000). However, these studies failed to include Korean adolescents, and they provide limited information on which school and community counselors working with Korean youth can base effective interventions. An alternative to the medical model is found in wellness approaches (Randall, 1996), which incorporate the tenets of positive psychology and the study of optimal human functioning, strength, and virtue (Sandage & Hill, 2001, Seligman, 1998) and offer the advantages of focusing on prevention, holism, and health or positive functioning (Hattie, Myers, & Sweeney, in press; Healthy People, 2000; Lightsey, 1996). These emphases are consistent with the philosophical approach of professional counselors (Locke, Myers, & Herr, 2001; Myers. 1992). To implement wellness interventions, counselors must first be able to assess holistic wellness, then apply specific interventions to enhance positive functioning (Myers, Sweeney, & Witmer, 2000). The assessment of wellness with minority populations represents a unique assessment challenge, in part because definitions of health and mental health vary across cultures (Larson, 1999) and in part because cultural considerations vary across populations, including Korean Americans (Jung, 2001). On the basis of these difficulties, combined with the relative recency of wellness research, it is not surprising that no studies to date have examined wellness among Korean Americans. Studies of related variables, such as well-being, have been limited to adult and older adult immigrant populations (e.g., Hyun, 2001). One possible reason for the lack of research on wellness among Korean American adolescents is the unavailability of personality instruments and, more specifically, wellness instruments that have been translated and culturally adapted for use with this population. The present study was undertaken to adapt and test a research instrument. Following a discussion of wellness and the Wellness Evaluation of Lifestyle (WEL; Myers, Sweeney, Hattie, & Witmer, 1997) and adaptation issues and methods, the procedures and results of field testing of the WEL Korean adaptation (Chang, 1998) are presented. The adequacy of the translated instrument, suggestions for future research, and implications for wellness assessment and counseling with Korean American adolescents are considered. WELLNESS: THEORY AND ASSESSMENT Dunn (1961), widely credited as being the "architect" of the modern wellness movement, defined wellness as "an integrated method of functioning which is oriented toward maximizing the potential of which the individual is capable" (p. 4). More recently, Archer, Probert, and Gage (1987) defined wellness as "the process and state of a quest for maximum human functioning that involves the body, mind, and spirit" (p. 311). Myers et al. (2000) defined wellness as "a way of life oriented toward optimal health and well-being in which body, mind, and spirit are integrated by the individual to live more fully within the human and natural community" (p. 252). This holistic focus has resulted in a variety of models that purport to encompass the broad range of attitudes and behaviors underlying the wellness construct. Models of Wellness Hettler (1984), a public health physician, was among the first to conceptualize the components of wellness. He described wellness in a hexagon model including six dimensions of healthy functioning: physical, emotional, social, intellectual, occupational, and spiritual. Two paper-and-pencil assessment instruments, the Lifestyle Assessment Questionnaire (LAQ; National Wellness Institute, 1983) and Testwell (National Wellness Institute, 1988), a shorter and more easily scored measure, were developed based on this model. Other researchers on wellness have proposed similar models with varying numbers of components. For example, Ardell (1977) developed a model of wellness that emphasized stress management and individual meaning and purpose through five broad dimensions: self-responsibility, nutritional awareness, stress awareness and management, physical fitness, and environmental sensitivity. Eight categories of behavioral change supplement the five dimensions: psychological and spiritual, physical fitness, job satisfaction, relationships, family life, nutrition, leisure time, and stress management. These models share a common basis in physical health sciences and a resultant emphasis on physical aspects or wellness. In contrast to earlier models, Sweeney and Witmer (1991) and Witmer and Sweeney (1992) developed a paradigm of wellness based on Adlerian counseling theory (Sweeney, 1998) as a foundation for integrating research across disciplines related to health, longevity, and quality of life. Several years of clinical and empirical studies led to a revision of their original Wheel of Wellness model (Myers et al., 2000), which defines five major overlapping and interacting life tasks as central to understanding healthy people. These include spirituality, work and leisure, friendship, love, and self-direction. Spirituality involves a sense of oneness with the universe. Work and leisure involve satisfaction with one's work and time spent in recreation and leisure. Friendship includes social relationships involving a sense of connection with others. Love includes an intimate, trusting relationship with another person. The life task of self direction further comprises 12 subtasks: sense of worth, sense of control, realistic beliefs, emotional awareness and coping, problem solving and creativity, sense of humor, nutrition, exercise, self-care, stress managements gender identity, and cultural identity. These life tasks interact with and are affected by a variety of life forces, including government, business and industry, and the media, as well as global events. The wheel model is the basis of the WEL, a paper-and-pencil assessment instrument Myers et al., 1997). Assessment of Wellness: The WEL Inventory The WEL, version S. is a 134-item instrument developed and revised over 10-year period (Myers et al., 1997). Earlier versions, the WEL-O, WEL-R, and WEL-G, were revised based on field testing of items and scales resulting in the most recent, or S, version. Items are statements written at a seventh-grade reading level to which respondents reply using a 5-point Likert-type scale ranging from A (strongly agree) to E (strongly disagree). Scores are numerical sums of item responses on five major scales and 12 subscales corresponding to the five life tasks in the Wheel of Wellness model. In addition, composite scores for total self-direction, a sum of the scores on the 12 subtasks of this dimension, and for total wellness, a sum of scores on all scales, are computed. The WEL may be administered individually or in groups and requires approximately 15 to 20 minutes for