The value of freedom: the introduction of option freedom in health-related capability wellbeing measurement

The capability approach has been used to develop instruments. However, the capability concept by Sen has been argued to be ambiguous concerning some elements of freedom, such as the burdens that people experience whilst achieving capabilities. Developing instruments with a comprehensive definition of capability might increase their sensitivity to a broader range of constructs. Our study operationalizes a framework based on the comprehensive “option freedom” concept into measurable constructs and presents an illustrative instrument. For this, the Multi Instrument Comparison (MIC) database was used. Items from the MIC database were matched to themes from a framework that had been developed in an earlier qualitative study. Then, a measurement model was constructed with the selected items and model fit was assessed. Lastly, an illustrative instrument was created that shows how the selected constructs can be measured concisely. A measurement model was constructed with 57 items and 11 factors. Data-driven explorative adjustments were made to improve model fit. Based on this model an instrument was developed with three scales (“Reflective Wellbeing”, “Affective Wellbeing” and “Perceived Access to Options”) totaling 15 items. This instrument showed adequate psychometric characteristics in terms of reliability and fit index values. This study shows how the concept of option freedom can be operationalized for health-related wellbeing assessment. Furthermore, the analysis indicates that in the context of outcome measurement, information about both capabilities and functionings related to subjective wellbeing is required to assess the overall wellbeing of an individual. Further research is needed to validate the instrument. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study did not receive any funding ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The ethics committee of the Heidelberg Faculty of Medicine of the University of Heidelberg gave ethical approval for this work. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes All data produced in the present study are available upon reasonable request to the study team of the Multi Instrument Comparison (MIC) project, which can be contacted at: https://www.aqol.com.au/index.php/mic-data