Paper short abstract:

We operationalize the capability approach using a structural equation model. The model uses data from adolescents living in Chitungwiza, to study the capability domains associated with their well-being. Our analysis will reveal the interdependencies among the capability dimensions, produce capability scores and identify the factors that influence an individual’s capabilities and functionings.

Paper long abstract:

Background

How can social or health policy-makers and program managers improve the overall well-being of adolescents living in Zimbabwe?

The first step is ensuring that policy- or decision-makers have access to appropriate adolescent well-being measurement tools. Such instruments should be capable of collecting relevant evidence and data that reflects, the complex and comprehensive experiences and realities that affect the well-being of adolescents. However, traditional adolescent well-being measurement tools are based on opulence and utility (Sen, 1985). One limitation with the use of such tools, is that they fail to record injustices, violations of rights and levels of deprivation or keep them concealed (Sen, 1999).

As an alternative to these welfarist measures of well-being, Amartya Sen conceptualized the Capability Approach (Sen, 1985, 1992, 1999, 2010). This approach proposes that judgements or evaluations of well-being should be based on what a person is able to do and be that is of value and importance to them. Under the Capability Approach framework, well-being is not measured in terms of an individual’s functionings (actual achievements, assets, or possessions). Instead, well-being is determined by the real opportunities available that give a person the freedom to decide what they will achieve – this is known as the capability set. Furthermore, these capabilities are shaped by the commodities (the means and resources to achieve) available to them in their context. In this paper, we use this approach as a framework to study and assess the well-being of adolescents living in the relatively low-resourced city of Chitungwiza, Zimbabwe.

Study Aim

For this study we have two goals. The first goal is to operationalize the Capability Approach using a multi-dimensional model that includes contextually relevant indicators. The second goal is to generate the individual capability scores of adolescents living in Chitungwiza, Zimbabwe, to assess their personal well-being.

Methods

Adolescent well-being is a multi-dimensional and latent construct. To measure adolescent well-being and operationalise the Capability Approach we are using structural equation modelling (SEM) which allows us to account for the various interconnected capability dimensions that characterise adolescent well-being and determine the role and influence of exogenous factors on the capabilities and functionings of adolescents living in Chitungwiza. The capability dimensions included in the model represent the five domains of the recently proposed adolescent well-being framework. These capability dimensions are: Health Capability (being able to access health services and make healthy choices), Relational Capability (being able to make positive relationships and contributions to society), Safety Capability (being able to live in an adequately safe environment), Knowledge/Employment Capability (being able to be educated or employed) and the Agency and Resilience Capability (being able to be resilient and make their own choices).

The structural model focuses on understanding which casual relationships exist among the endogenous latent constructs (capability dimensions) that constitute adolescent well-being. For example, we will use the model to determine if there is an association between the Health and Safety Capability, and if the relationship is mutual or one-directional. While capability domains may have simultaneous influence over one another, they are also prone to other external causes that also influence them. Through the structural model equations, we will also ascertain which exogenous (observable) variables have an effect on the various capability domains, helping us determine for example, whether exogenous variables such as the socio-economic status (SES) of an adolescent could impact their Health Capability or Safety Capability. Additionally, we will generate capability indices which we will use to assess the adolescents’ state of well-being as suggested by Sen.

The second part of a SEM is the measurement model. It seeks to identify relationships between capabilities (latent variables) and functionings/achievements (observable variables), and illustrate the role capabilities play in the achievements made. Included in the measurement equations are other exogenous variables that influence the adolescent’s achievements. These set of equations are important as they may help explain why adolescents who are exposed to the same capabilities have different levels of functioning/achievement.

This research is nested within Y-Check, a study that aims to evaluate a novel and comprehensive, youth-friendly health check-up that screens and offers treatment/referral for 20 conditions and behaviours including common mental disorders, oral health, physical impairment, and nutrition. The model built for this research uses data from the Y-Check study population which comprises of 2000 adolescents, between 10-19 years of age. Participants were recruited from primary school, high school, and community settings.

The data that is being used includes self-reported information on education, participation in sports, social support, health conditions, health access and usage, risky behaviours, socioeconomic status, household characteristics, living conditions, agency, and other personal information (e.g. self-esteem). Other variables included in the analysis, which were collected separately from the individual-level data, relate to district-level and school-level data (e.g., number of medical facilities, and water coverage, number of classrooms, presence of sports facilities, access to clubs, and cultural activities etc.)

Results

The analysis is currently underway. From the results of the model we will be able to:

1. Specify interdependencies among the different capability dimensions mentioned above

2. Calculate the individual capability scores for each adolescent

3. Identify the factors that are associated with an individual’s capabilities

4. Determine which individual or household characteristics and capabilities are associated with an adolescent’s level of functioning/achievement.

I will share the preliminary findings from this work-in-progress during the session to solicit feedback from the HDCA community.

Implications

The empirical results will provide a reference for social and health policy makers to use when developing programmatic and policy efforts that improve and protect the overall well-being of adolescents living in and around Chitungwiza. The findings will also highlight opportunities to strengthen multisectoral and intersectoral collaborations aimed at promoting adolescent well-being. As an empirical study, the model can serve as a tool in measuring the well-being of local adolescents.