Summary in plain English.

There are many opinions as to what you should ask employees when measuring employee well-being, mental health, and job satisfaction. Zoios use a data-driven approach where the most powerful questions, according to the statistical analyses, are used.

All questions stem from evidence-based validated questionnaires, and they have been carefully designed to work with employees. The 11 questions represent Well-being, Mental Health (stress), and 8 essential drivers. We also have an extra question on Employee Net Promoter Score as well as a control question in the end. We ask questions in a manner where a low score always indicates a challenge, which makes them essential.

If you want to understand why employees are, or are not, happy and satisfied with their job and workplace, then our 11 questions explain the vast majority of that why. The other advantage is we have built a playbook, guides, training, videos, idea bank, root causes, workshops, and benchmarks around these questions to ensure you know whether a score is good or bad, what’s the underlying root cause and how you can act on it.

Abstract.

Zoios is a research-based model for measuring job satisfaction, the framework behind the model builds upon validated instruments from the literature on mental health and job satisfaction, providing a solid foundation for its assessments. Zoios utilizes a fixed, defined questionnaire framework, ensuring that the questions effectively uncover a large portion of employees' job satisfaction. This model undergoes continuous testing and refinement to remain up-to-date and reliable.

In many well-being surveys, you can put together your own questionnaire framework. This is not the case in Zoios. Zoios has a fixed defined questionnaire framework because we know that these questions, together, uncover a large part of the employees' job satisfaction.

The applied calculation model combines regression and factor analyses to calculate relationships between the dependent variable (job satisfaction) and a series of independent variables (eight drivers). The model is continuously reviewed, particularly when new languages and organizations from new countries outside Denmark join Zoios. While the explanatory power of the model may vary across languages and cultures, local refinements to the survey maintain its high explanatory power. It is relevant to note that there are a lot of languages and cultures where we have no hard evidence for the explanatory power of the model, yet. In fact, we definitely do expect deviations in results and local refinements to the survey to keep the high explanatory power.

The eight drivers measured by Zoios are based on thorough research and analysis of Danish and international studies. After pilot tests and refinements, these factors were found to account for 69% of employee satisfaction across various industries, genders, ages, and job types. Although not encompassing the full scope of job satisfaction, these factors provide an excellent foundation for improving workplace well-being.

Zoios' fixed questionnaire framework fosters a shared language and reference for job satisfaction and the eight drivers within an organization. It enables benchmarking against industry standards and comparisons across industries and professional groups. Additionally, organizations can include custom qualitative questions related to specific interests or current issues.

Below are the questions (items) from the Zoios Survey Framework as well as the items from existing validated instruments that the questions are based on:

Mental Health Continuum Short Form (MHC-SF) Item 1: ” How often did you feel that you had something important to contribute to society?” Item 2: ”How often did you feel that you accomplished something worthwhile?”

SRHM: Item: ”How often have you felt that you were accomplishing the things you set out to do?” | Contribution | | 2. | How satisfied are you with your personal- and professional development? | Personal Well-being index: "How satisfied are you with your personal growth?”

Subjektiv livskvalitet: ”I have the opportunity to develop myself personally”

MHC-SF ”I have been making progress in my personal growth.”

SRMH: ”How much progress have you made in your personal development?” | Development | | 3. | How often do you feel nervous or "stressed"? | Perceived Stress-Scale (PSS) Item: ”In the last month, how often have you felt nervous and "stressed"?” | Mindful/stress | | 4. | How often do you feel comfortable solving your problems and challenges? | Perceived Stress-Scale (PSS) Item: ”In the last month, how often have you felt confident about your ability to handle your personal problems?”

Flourishing: Item: ”How often do you feel that you are confident and capable of handling life's challenges?” | Mindful/stress | | 5. | How often do you feel optimistic about the future? | Positive Mental Health Scale, PMH-Scale: ”I feel optimistic about the future”

Warwick-Edinburgh Mental Well-being Scale, WEMWBS: "I feel optimistic about the future” | Optimism | | 6. | To what degree do you feel that you are being recognised and rewarded for your work? | Job Satisfaction Survey (JSS) "When I do a good job, I receive the recognition for it that I should receive.” | Recognition | | 7. | How satisfied are you with your social relationships at work? | Personal Wellbeing Index (PWI): "How satisfied are you with your personal relationships?” | Social | | 8. | To what degree do you feel that you get the necessary help and support from your colleagues (and manager)? | Personal Wellbeing Index, PWI: "How satisfied are you with the support you get from friends? | Support | | 9. | How satisfied are you with your work-life balance? | SGWB "Overall, how satisfied are you with the balance of your life?”

Personal Wellbeing Index (PWI): ”Overall, how satisfied are you with your life these days?” | Work-life | | 10. | How likely is it that you would recommend  [Name of organization] as a workplace to a friend or an old colleague? | Reichheld (2003) “how likely is it that you would recommend our company to a friend or colleague?” | eNPS | | 11. | Overall, ****how satisfied are you with your job? | Job Satisfaction Survey (JSS) "I feel satisfied with my job.” | Control question | | (12.) | How often do you feel that your interest or pleasure in doing things is low? | PHQ-4 ”Little interest or pleasure in doing things” | Additional Stress | | (13.) | How often do you find it difficult to cope with all the things you have to get done? | Perceived Stress Scale (PSS), Cohen et al ”In the last month, how often have you found that you could not cope with all the things that you had to do?” | Additional Stress |

Research overview.

The information below is an overview of the research and work behind the Zoios Survey Framework. It provides literature reviews as well as discussions on mental health. Further, it touches upon the differences between mental health and mental fitness and how to understand and investigate these in the context of the employee and the workplace, focusing on job satisfaction, stress and well-being. The Zoios Survey framework is introduced, with background an explanation of the intentions and guiding principles behind the study. The information below also addresses the challenge of survey fatigue and discusses the application of academic research in real-world settings. Finally, the methods and evaluation of the study are outlined, and the results, questions, and drivers of well-being at work are presented.

Mental health.

Mental health refers to a person's overall psychological well-being, including their emotional, social, and cognitive functioning (World Health Organization, 2014). Mental health has been an area of interest in literature, psychology, and public health research for many years. Traditionally, the focus of mental health research has been on the identification, diagnosis, and treatment of mental illness. However, more recently, there has been growing interest in, and recognition of the importance of positive mental well-being, which refers to the presence of positive emotions, engagement, positive relationships, meaning, and accomplishment (Seligman, 2011). In other words, Mental health as a field of study has in recent decades expanded with branches focusing on positive mental well-being as opposed to mental health illness and issues.

Studies have shown that positive mental well-being is associated with a range of benefits, including better physical health outcomes, improved coping skills, and increased resilience in the face of stress and adversity (Keyes, 2007; Ryff & Singer, 2008). In literature, positive mental well-being is often portrayed through characters who exhibit traits like optimism, hope, and resilience in the face of challenges (Tugade & Fredrickson, 2004). Moreover, reading about positive mental well-being in literature has been shown to have a positive impact on readers' own mental health and well-being (Tse et al., 2019).

Overall, and not surprisingly in todays world, the literature suggests that positive mental well-being is an important aspect of mental health that should not be overlooked. Incorporating positive mental well-being into mental health research and literature can provide insights into the factors that promote resilience, coping, and thriving, which can ultimately inform interventions that promote positive mental health outcomes.

Mental health vs. Mental fitness.

As can be deducted from the short literature review above, the term mental health surfaced in relation to illness and this still influence and characterize how we understand the term today, which is also why the term still, to some degree, has a bad reputation in society due to these underlying connotation of mental health issues; anxiety, stress and depression. This is likely worsened by the interventions associated with the improvement of mental health, like therapy, psychologists, medication, meditation and other often taboo practices. However, to break out of this traditional paradigm, as recent research has also done, one thing to remember, which most people often forget, is that you can work with and improve mental health without having mental health issues. Just like a professional football players, dancers or runners can improve their physical shape, skills and performance although they are already in the top 1% today. Well, just like you can improve at your job. Does that mean that you are poor at it today? or have issues performing it? The answer to that of course is, no.

Another common pitfall or subconscious misconception regarding the term mental health is that it is a static thing, reflecting a mental state. Sure, this can be analyzed, but it seems timebound and like a fixed destination, automatically indicating that one can be in a good or bad state or, in other words, that one can have mental health or not. Taking it further, it sounds like if you do not have mental health, if you are not perfect, then there is something wrong with you. Any kind of divergence or sadness means that you are imperfect, and that is just not true and works counterproductive in the pursuit of mental well-being. Because of this we believe, it is an unfair standard to call it mental health.

If we compare mental health to physical health and the body when going to the gym or exercising, then somedays you have good days at the gym, some days you have bad days. Somedays your body feels amazing and you can lift a lot of weights, but other days, for some reason, you have been eating well, you slept well, you are hydrated, but your body is just not working that well. We are all familiar with those days and it does not really bother us that much. Instead we say: “hey, I had a bad day today”, we allow that to happen and then we move on. However, we do not treat our mental health the same way.

We believe you are 100% mentally fit if you have sadness, joy, doubt, satisfaction, uncertainty, serenity and insecurity. That is what it is to be human, your body, as well as your mind have pain sometimes, but that does not mean something is wrong with your body or mind. That is why we like to call it mental fitness instead of mental health, because that allows us space to work and improve. This way mental health becomes dynamic and we can always be working on our mental fitness, while allowing for periods of darkness, bad times, and bad days. That does not make us unhealthy, instead it allows for working on the things that are not as we want them to be.

Ultimately, if we do not have off-days or weeks, how do we know what good and great days looks like and how would we know to appreciate the happy days if we did not have some days where we feel a bit down?

Mental health in the workplace.

We have briefly covered mental health in general and its emergence in literature and further problematized how the term is most often understood today. Now, let’s direct the focus to the place where we spent most of our waking hours, the workplace. Mental health and well-being are increasingly recognized as critical factors in the workplace. A growing body of literature suggests that promoting positive mental health and well-being at work can have significant benefits for both employees and employers. This literature review will summarize some of the key findings from recent research in this area.

One of the key factors influencing mental health and well-being at work is job demands. High job demands, such as excessive workloads or time pressure, can lead to stress and burnout, which can negatively impact mental health. A study by Hakanen et al. (2020) found that high job demands were associated with increased risk of depression and anxiety among employees.

However, the relationship between job demands and mental health is complex, and it also depends on employees' resources and support systems. For example, a study by Bakker et al. (2020) found that job demands were only detrimental to mental health when employees lacked resources such as autonomy and social support.

Another important factor in mental health and well-being at work is work-life balance. Research suggests that employees who feel they have adequate time for personal and family life experience better mental health and well-being (Greenhaus & Powell, 2021). Flexible work arrangements, such as telecommuting or flexible work hours, can help employees achieve a better work-life balance.

Organizational culture also plays a crucial role in mental health and well-being at work. A positive work environment that promotes open communication, trust, and support can help employees feel valued and connected, leading to better mental health and well-being (Babakus et al., 2020). Employee engagement, which is fostered by a positive work environment, is also strongly linked to mental health and well-being (Huang et al., 2021).

Finally, resources and support for employees who may be struggling with mental health issues are critical in promoting mental health and well-being at work. This can include Employee Assistance Programs (EAPs), mental health resources, and training for managers and supervisors on how to support employees with mental health issues (Gao et al., 2021).

Overall, promoting mental health and well-being at work requires a multifaceted approach that addresses job demands, work-life balance, organizational culture, resources and support, and more for employees. By prioritizing mental health and well-being in the workplace, organizations can create a healthy and productive workforce, leading to better business outcomes and a better quality of life for employees. A true win-win as we call it here at Zoios.

Well-being in the workplace.

Workplace well-being has become an increasingly important area of research in recent years. Well-being can be defined as a state of happiness, satisfaction, and overall life satisfaction, and it is influenced by a variety of factors within and outside of work.

One of the most important factors in workplace well-being is job satisfaction. Research has consistently shown that employees who are satisfied with their jobs experience higher levels of well-being and are less likely to experience stress and burnout (Judge et al., 2017). Job satisfaction can be influenced by a variety of factors, including job autonomy, social support, and job fit.

Another important factor in workplace well-being is workplace culture. A positive workplace culture that emphasizes respect, communication, and teamwork can have a significant impact on employee well-being (Diener et al., 2018). Organizations that prioritize employee well-being and create a supportive work environment can promote a positive workplace culture that fosters well-being.

Work-life balance is also critical to workplace well-being. Employees who are able to achieve a healthy work-life balance are more likely to experience well-being and are less likely to experience burnout (Greenhaus and Allen, 2011). Flexible work arrangements and policies that promote work-life balance, such as paid time off, can help employees achieve a healthy balance between work and personal life.

Finally, employee wellness programs and initiatives can also promote workplace well-being. Wellness programs can include initiatives such as fitness challenges, mental health resources, and healthy food options in the workplace (Rongen et al., 2018). These programs can help employees develop healthy habits and promote overall well-being.

In conclusion, workplace well-being is a multifaceted issue that requires a comprehensive approach. By addressing job satisfaction, workplace culture, work-life balance, and employee wellness programs, and more, organizations can create a supportive and healthy workplace environment that promotes well-being.

Work or workplace related stress.

Stress in the workplace is a significant issue that can have negative impacts on both employees and organizations. A growing body of research has highlighted the impact of work-related stress on employee mental and physical health, job satisfaction, and organizational productivity.

One of the key issues in stress in the workplace is job demands. Research has consistently shown that high job demands can contribute to work-related stress, particularly when employees feel that they lack control over their work (Schaufeli et al., 2008). Job demands can include factors such as workload, time pressure, and conflicting demands.

Another important factor in stress in the workplace is job resources. Job resources such as social support, autonomy, and feedback can help employees cope with job demands and reduce the risk of work-related stress (Bakker and Demerouti, 2017). By providing employees with the resources they need to perform their jobs effectively, organizations can help to reduce stress and promote well-being.

Organizational culture and leadership also play a critical role in stress in the workplace. Research suggests that a negative work environment that is characterized by low social support, low job control, and a lack of respect can contribute to work-related stress (Leka et al., 2015). Leaders who prioritize employee well-being and create a positive work culture can help to reduce stress and promote well-being.

Surveys have been shown to be effective in measuring employee stress levels in the workplace (Nieuwenhuijsen et al., 2010). These surveys can be administered anonymously to employees and can cover a range of topics, including workload, job control, social support, and organizational culture. Popular survey tools is the Job Content Questionnaire (Karasek, 1985), and The Perceived Stress Scale (Cohen et al., 1983) measuring stress levels and can provide valuable insights into employees' perceptions of their stress levels. By using surveys to measure stress levels, organizations can gain a better understanding of the factors contributing to work-related stress and develop targeted interventions to address them. Additionally, regular surveys can help organizations track changes in stress levels over time and evaluate the effectiveness of their stress reduction initiatives (Van der Doef & Maes, 1999).

In conclusion, stress in the workplace is a complex issue that can have negative impacts on employees' mental and physical health, job satisfaction, and organizational productivity. High job demands and low job resources are key factors that contribute to work-related stress. However, by providing employees with the necessary resources and support, creating a positive work culture, and developing targeted interventions based on surveys, organizations can reduce stress and promote employee well-being. Here, surveys can provide valuable insights into the factors contributing to stress in the workplace, allowing organizations to track changes in stress levels over time and evaluate the effectiveness of their stress reduction initiatives.

Job satisfaction.

Let’s start of by making a distinction between employee job satisfaction and employee well-being, as these can easily blur together, if not paid attention to. So, while employee job satisfaction and employee well-being are related, they are distinct concepts. Employee job satisfaction refers to how satisfied employees are with their job and specific job-related factors such as their work environment, compensation, and benefits (Macey & Schneider, 2008). On the other hand, employee well-being encompasses a broader range of factors, including physical health, mental health, work-life balance, and overall quality of life (Kahneman, Diener, & Schwarz, 1999). Research has shown that while job satisfaction is important, it is not always a reliable indicator of employee well-being (Wright & Cropanzano, 1998). For example, an employee may be satisfied with their job but still experience stress and burnout due to long hours or a lack of work-life balance. Therefore, it is important for organizations to focus on both employee job satisfaction and well-being to promote a healthy and supportive work environment for their employees.

With that distinction in mind, let’s explore and unfold job satisfaction a bit more. Job satisfaction is a complex concept that can be difficult to define. Generally speaking, it refers to how satisfied an employee is with their job and the specific factors that contribute to that satisfaction. Some common factors that contribute to job satisfaction include compensation, job security, work-life balance, and opportunities for growth and advancement (Judge, Thoresen, Bono, & Patton, 2001). Additionally, job satisfaction is often linked to employee motivation and productivity, as satisfied employees are more likely to be engaged and committed to their work (Saks, 2006).

Measuring job satisfaction can be challenging, as it is a subjective concept that can vary greatly from person to person. However, there are several common approaches to measuring job satisfaction, including self-report surveys, interviews, and focus groups (Spector, 1997). These methods typically ask employees to rate their satisfaction with various aspects of their job on a scale.

One key area of research related to job satisfaction is understanding the factors that contribute to it. For example, research has shown that job satisfaction is influenced by both individual factors, such as personality and work-related values, and environmental factors, such as the work environment and organizational culture (Judge et al., 2001). Additionally, job satisfaction can be impacted by factors such as job stress, burnout, and job insecurity (Saks, 2006). Understanding these factors is important for employers looking to promote job satisfaction and create a positive work environment for their employees.

In conclusion, job satisfaction is a complex and multifaceted concept, impacted by a lot of factors. Besides more tangible things such as compensation and advancement, job satisfaction is influenced by well-being (e.g. worklife, culture, social support) and stress burnout. By addressing these many factors organizations can influence employees perceived job satisfaction leading to higher productivity, engagement and organizational success.

Zoios Philosophy.

The above provides an overview of the basis upon which the Zoios Survey Framework was developed. Before diving more into the development of the survey instrument there are a few important remarks to be made.

There is no doubt that we live in an era of great advancements and that our standards of living and welfare have reached unprecedented heights. For example, extreme poverty rates have decreased, life expectancy has increased, and access to education and healthcare has improved (World Bank, 2022). However, despite these achievements, there is still much room for improvement. One area where this is particularly evident is the healthcare sector. Too often, healthcare systems are reactive and focus on treating diseases and illnesses, rather than preventing them. For instance, in many countries, huge amounts of money are spent on treating diseases caused by smoking, rather than investing in measures that can help people quit smoking. Similarly, many people with cardiovascular diseases are treated with medication, rather than being encouraged to adopt healthy lifestyle habits that could prevent these conditions from arising in the first place. This point and its importance can not be overstated, so we will take two studies to underline it. A study published in the Journal of the American Medical Association found that more than half of all healthcare spending in the United States is devoted to treating preventable chronic conditions (Dieleman et al., 2016). Similarly, a report by the World Health Organization found that noncommunicable diseases (disease typically caused by unhealthy behaviours), e.g. heart disease, diabetes, lung disease, which are largely preventable, account for 71% of all deaths worldwide (WHO, 2018). These statistics clearly demonstrate the need for a shift in focus towards preventive measures in the healthcare sector.

These reactive approaches are not just found in public healthcare, but for example also in corporate insurance policies, which often delay access to therapy or psychological support until an employee has been off sick for a certain period of time. If we want to make significant progress in healthcare and the well-being of people, we need to shift our focus from treating symptoms to preventing illness, which will require shift in mindset and a long-term commitment from academia, private companies, and government policy-making. It will take one if not more generations to pull through and flip the healthcare systems (and others) focus from treating symptoms and disease to preventing them. This will not come by itself, academia needs to push on, while private companies need to take responsibility, invest and show the way and the power of preventive measures. Here at Zoios, we take on that responsibility. We seek to be proactive, searching for new and more ways of being preventive in relation to mental and physical well-being.

Background, motivation and focus.

Lastly, we want to put a few words on the background, motivations and focus. Our focus on well-being and stress in the workplace sprung out of a deep frustration. As mentioned, we are at unprecedented heights in relation to welfare and standards of living, but also collective intelligence. While this is true, it is unfortunately also true that work-related stress has been increasing over the last two decades. This is unacceptable and needs to change and this is the frustration that directed us towards focusing on individuals well-being and stress at work to begin with. We can and must do better. To provide a bit of insight into this unfortunate development the European Agency for Safety and Health at Work EU-OSHA found in one of their studies that stress-related disorders are one of the most common work-related health problems in Europe and that the prevalence of work-related stress has been increasing in recent years. More recently, the COVID-19 pandemic has also contributed to an increase in work-related stress, with many employees experiencing new challenges related to remote work, job insecurity, and increased workloads. Likewise, one study conducted by the American Psychological Association (APA) found that stress levels in the workplace have increased significantly since the late 1980s, with approximately 65% of employees reporting higher levels of workplace stress than previous generations.

The Zoios Survey Framework.

Intentions & Guiding Principles.

The intentions and goals of the project were to create a survey instrument that accurately measures employee well-being, stress and job satisfaction. Based on the research mentioned above we had a hypothesis of a strong, but complex, relationship between these concepts. Adding to this there was a range of guiding principles applied to steer the development of the survey instrument. The guiding principles are briefly described here:

1. Tackling the survey fatigue dilemma.

Survey fatigue is a common phenomenon in which participants (employees) become tired or disinterested in completing one or multiple surveys, leading to reduced response rates, increased likelihood of missing data, and potentially biased results. In mental health research, this dilemma is particularly relevant, as surveys and other self-report measures are frequently used to assess psychological symptoms, and other key variables.

One of the primary concerns with survey fatigue in mental health research is that it can lead to non-response bias, whereby individuals who are more likely to drop out of a study or skip certain questions may differ systematically from those who complete the survey in full. This can make it difficult to draw accurate conclusions about the population of interest (the organization), and can limit the generalizability of findings.

Furthermore, survey fatigue can be particularly problematic when studying mental health, as individuals with mental health conditions may be more prone to fatigue or other factors that reduce their ability or willingness to complete surveys. This can make it challenging to obtain representative samples of individuals with certain diagnoses or conditions, or to collect data on important outcomes over time.

2. High response rate.

This principle is very much related to the challenge we intended to solve above. One could say it is the successful result of overcoming the challenge. Nonetheless, we wanted to explicitly include it as a principle, because high response rates are essential in quantitative well-being studies. They ensure that the sample is representative of the population of interest and that the results are reliable and accurate. In other words, a high response rate is necessary to obtain valid data that accurately reflects the experiences and opinions of the population being studied.

When response rates are low, there is a risk of non-response bias, where the participants who do not respond to the survey may differ systematically from those who do. For example, people who are experiencing more severe mental health challenges may be less likely to respond to a survey about well-being, which could bias the results and make it difficult to draw accurate conclusions or provide an accurate overview of an organization.

High response rates would also assist us in maximizing the statistical power of our insights. A larger sample size generally provides greater precision in estimating population parameters, reducing the risk of random error in the results. Additionally, a high response rate makes it possible to conduct subgroup analyses and examine individual differences, which can provide important insights into how well-being varies across different segments or groups.

Finally, high response rates increase the external validity of a study, making it more likely that the findings can be generalized to the population of interest. This is particularly important in well-being research, where the goal is often to identify factors that promote or hinder well-being across diverse populations.

Overall, a high response rate is crucial in quantitative well-being studies to ensure that the results are accurate, reliable, and representative of the population being studied.

3. Quality.

In quantitative well-being studies, quality refers to the overall validity and reliability of the study design, measures, and data analysis. Quality is important because it ensures that the study produces accurate and trustworthy results that can inform for example decision making.

A well-designed study should use reliable and valid measures to assess well-being, such as established scales and questionnaires. The sample should be representative of the population of interest and the study should use appropriate statistical methods to analyze the data. Additionally, the study should address potential confounding variables that could affect the results and use appropriate controls to account for these factors.

Ensuring quality in a well-being study helps to minimize the risk of bias and confounding, which can affect the validity of the results. A high-quality study design, data collection, and analysis also increase the likelihood that the study findings will be reproducible, meaning that the same results would be obtained if the study were repeated with a different sample or under different conditions. This increases confidence in the results and their usefulness in informing policy and practice.

Overall, ensuring quality in quantitative well-being studies is crucial for producing accurate and trustworthy results that can inform decisions and policies aimed at improving well-being.

Solving the survey fatigue challenge.

Here at Zoios we appreciate academia and scholars dedicated to research, this is what has enabled us to do what we do. However, researchers writing articles and papers are working under constraints and high requirements when it comes to reliability and validity of their findings. This is especially true in the field of social and psychological sciences. To develop a survey framework that intends to understand, reflect and explain constructs such as mental health, stress, wellbeing and psychological safety scholars need to ask a lot of questions. In other words, the more questions (items) in a questionnaire the more granularity and nuance of the analysis. However, that does not necessarily mean better overall results in the real world, considering e.g. response rate and non-response bias. In research, often times you have to ask and include questions that only to a very little degree explain or capture the measure they are intended to measure, just to figure out which other questions actually do the better job here. That is science, and strengthens the conclusion of which questions really do measure the construct(s) they are intended to measure (Construct validity). Luckily, researchers have also faced the challenges of having too long surveys resulting low response rates and respondent drop-offs, which then can reduce the generalizability and external validity of the survey. The solution to this problem is called item reduction, where the total amount of items are reduced down to a subset to still capture the essentials, but in a shorter, more concise format. This is explained and visualized below.

An example of item reduction to tackle the survey length and survey fatigue challenge (Ware et al. 1998 at Medical Outcome).

Let’s take a moment and explain this with an actual case. The case is based on the work of Ware, Kosinski, & Keller (1996), that as part of their work developed a health survey for assessing and understanding patient health. Their work led to a 36-item survey that has then been boiled down to a short form survey of only 12-items (known as SF-12). So why is that? Well, the short-form survey instrument provides a solution to the problem faced by many investigators (scholars, as well as practitioners) who must restrict survey length. The SF-12 was designed to reduce respondent burden while achieving minimum standards of precision for purposes of group comparisons involving multiple health dimensions. See the illustration below for the visual idea of how this works statistically.

The example on the left from the SF-36 uses 9 individual items, 5 of these are serve as the measure to measure and understand the construct, emotional well-being. But, some items explain more than others, which is why the SF-12 on the right only has 3 items, where 2 of them measure the same construct, emotional well-being. The goal being to have as much precision in capturing the construct, emotional wellbeing, with as few items (questions) as possible.

In conclusion, the more question you ask the more you can potentially capture, that is undeniable. However, the more questions you ask the less likely it is that respondents will answer, especially survey after survey. Hence, the idea is to capture as much as possible with as few questions as possible, while still maintaining minimum standards of precision.

Methods.

Desk research.

As should be clear from the above, trying to understand and measure mental health and underlying concepts as well-being and stress is an established field of research. Most of this research focus on the general population and the individuals mental health in general (worklife and private life). This research served as the starting point for developing the survey framework. Here is an overview of the instruments included in our research, these are also among the most validated and commonly used instruments for measuring mental health:

1. Patient Health Questionnaire-9 (PHQ-9): This is a self-administered questionnaire that is used to measure the severity of depression. It consists of nine items, each of which assesses a specific symptom of depression.
2. The Mental Health Continuum-Short Form (MHC-SF): The MHC-SF is a brief questionnaire that assesses an individual's mental health and well-being by measuring their emotional, psychological, and social functioning. The scale uses a Likert-type response format, with items rated on a scale from 0 (never) to 5 (every day) to indicate the frequency of various emotional experiences
3. Generalized Anxiety Disorder-7 (GAD-7): This is a self-administered questionnaire that is used to measure the severity of anxiety. It consists of seven items, each of which assesses a specific symptom of anxiety.
4. Beck Depression Inventory (BDI): This is a self-administered questionnaire that is used to measure the severity of depression. It consists of 21 items, each of which assesses a specific symptom of depression.
5. Beck Anxiety Inventory (BAI): This is a self-administered questionnaire that is used to measure the severity of anxiety. It consists of 21 items, each of which assesses a specific symptom of anxiety.
6. Symptom Checklist-90-Revised (SCL-90-R): This is a self-administered questionnaire that is used to measure a broad range of psychological symptoms. It consists of 90 items, each of which assesses a specific symptom.

Through this research it became apparent, that most mental health scholars and articles still occupy themselves with measuring mental health issues with the purpose of diagnosing patients (e.g. depression, anxiety). Naturally, this is super meaningful, but less so in our context, as it was not intention to diagnose employees. During our own research of mapping out the different instruments for measuring mental health, positive mental health, well-being and stress we encountered a great paper, Mental Sundhed - Kortlægning af måleredskaber, (Mental health - Mapping the Instruments), by The Danish National Institute of Public Health. In their paper they evaluate 11 instruments for mental health targeting the general population. The instruments are listed below with descriptions (the MHC-SF instrument has been removed below, as it is described above):

1. Flourishing: The Flourishing scale is a tool that measures an individual's overall sense of flourishing, which encompasses feelings of happiness, engagement, and meaning in life. The scale uses a Likert-scale response format, with items rated on a scale from 1 (strongly disagree) to 7 (strongly agree).
2. Personal Wellbeing Index, PWI: The PWI is a tool that assesses an individual's subjective well-being by measuring their satisfaction with various aspects of their life, including relationships, health, and material possessions. The scale uses an 11-point response format, with individuals rating their satisfaction with various aspects of their life on a scale from 0 (completely dissatisfied) to 10 (completely satisfied).
3. Positive Mental Health Scale, PMH-Scale: The PMH-Scale is a questionnaire that measures an individual's level of positive mental health, which includes characteristics such as optimism, resilience, self-esteem, and positive emotions. The scale uses a Likert-scale response format, with items rated on a scale from 1 (never) to 6 (always) to indicate the frequency of various positive mental health characteristics.
4. Psychological General Well-Being Index, PGWBI: The PGWBI is a tool that measures an individual's psychological well-being by assessing their sense of purpose, self-acceptance, positive relations with others, personal growth, environmental mastery, and autonomy. The scale uses a Likert-scale response format, with items rated on a six-point scale from 0 (not at all) to 5 (completely) to assess an individual's psychological well-being.
5. 12-Item Short Form Survey, SF-12: The SF-12 is a widely used tool that assesses an individual's general health status and overall well-being, including their physical and mental health. The scale uses a Likert-type response format, with items rated on a scale from 1 to 5 to indicate the level of difficulty an individual experiences with various physical and mental activities.
6. Self-rated mental health, SRMH: The SRMH is a single-item tool that asks individuals to rate their own mental health on a scale from poor to excellent. The scale uses a single-item Likert-type response format, with individuals rating their own mental health on a scale from 1 (poor) to 5 (excellent).
7. Scales of General Well-Being, SGWB: The SGWB is a multidimensional tool that assesses an individual's overall sense of well-being, including their satisfaction with life, positive mood, and absence of negative symptoms. The scale uses a Likert-scale response format, with items rated on a seven-point scale from 1 (strongly disagree) to 7 (strongly agree) to assess an individual's overall sense of well-being.
8. Warwick-Edinburgh Mental Well-being Scale, WEMWBS: The WEMWBS is a tool that measures an individual's mental well-being by assessing their subjective experiences of happiness, self-esteem, and social connectedness. The scale uses a Likert-scale response format, with items rated on a five-point scale from 1 (none of the time) to 5 (all of the time) to measure an individual's mental well-being.
9. WHO-5: The WHO-5 is a brief tool that assesses an individual's level of mental health and well-being by measuring their positive mood and absence of negative symptoms. The WHO-5 uses a Likert-type response format, with individuals rating the frequency of various positive and negative feelings on a scale from 0 (not present) to 5 (constantly present) over the past two weeks.
10. Subjektiv livskvalitet: Subjektiv livskvalitet is a tool that assesses an individual's subjective well-being by measuring their overall satisfaction with their life, including their relationships, health, and material possessions. Subjektiv livskvalitet uses a Likert-scale response format, with items rated on a scale from 1 (very dissatisfied) to 7 (very satisfied) to assess an individual's subjective well-being.

Other instruments went into the overview and mapping of existing validated frameworks, some worthy mentions here are The Percieved Stress Scale (PSS) developed by Cohen, Positive and Negative Affect Schedule (PANAS), Satisfaction With Life Scale (SWLS), Subjective Happiness Scale (SHS), Ryff's Scales of Psychological Well-being (SPWB), And Psychological Well-being Scale (PWBS). After mapping out and categorizing the types of instruments, but also the types of measures and construct they were designed to measure we had an overview and a great bank of validated items to rely on.

Continuing the research we directed our attention to factors for motivation, engagement, satisfaction and well-being in the workplace. This consisted of studies and reports conducted and published by Gallup, McKinsey, Gartner, Deloitte and PwC. These reports investigating the most important factors for employees job satisfaction and well-being. This included both historic, current as well as predictions for future factors and their priority for the employee. Crossing the insights and connecting the dots between mental health in general and critical factors in the workplace led to the below survey framework. The questions are founded in the most validated mental health instruments, and contextualized to the work life setting when necessary.

Zoios Survey Questions.

Scale type.

The scale used for the above questions is a type of likert scale. It ranges from 0 to 5. There are multiple reasons for why this scale was chosen. Firstly, this is the same scale used by e.g. WHO-5, which means it is commonly used, validated and something most people are alredy familiar with. Further, the 0 to 5 scale is easier to use and understand for respondents than fx the 1 to 7 likert, as it has fewer response options and a simpler format. Adding to this the 0 to 5 scale reduces the likelihood of respondents choosing a neutral midpoint option, as there is no true neutral option on this scale. This in turn can result in more accurate and reliable data.

Testing the survey.

The survey was tested with a sample of employees, ensuring that every employee had an equal chance of being selected. Next, the survey was pilot tested with a smaller subset of the sample to identify any potential issues or confusing questions. Based on the results of the pilot test, revisions were made to the survey framework to ensure clarity and accuracy. Finally, the survey was distributed to the full sample, and data was analyzed to assess the representativeness of the sample. This included checking for any biases, such as age or gender, and comparing the sample to known population characteristics. Any discrepancies were addressed through weighting or stratification to ensure the final results were representative of the employee population.

Employee interviews.

As part of the iterations employee interviews were conducted with the purpose of strengthening the content and face validity of the items and survey framework as a whole. These interviews also provided valuable insights as well as a feedback regarding which questions where easy to consume and understand or hard to answer. Further, what employees thought of when answering these questions. In other words, what context did the employee understand the questions and answers related to time, feelings and topics. An in depth overview of this work can be found here [link].

Statistical analysis. [Currently being updated with latest sample data]

Evaluation.