Article Information

Inês dos Santos Silva¹, Luísa Soares², Frank Schifferdecker-Hoch^1,3

¹2256c.health Unipessoal LDA, Lisbon, Portugal

²Universidade da Madeira, Funchal, Portugal

³FPZ GmbH, Cologne, Germany

Author’s orchid numbers: Inês dos Santos Silva Orcid:0000-0003-3373-971X, Luísa Soares Orcid: 0000-0002-5373-1320

^*Corresponding author: Inês dos Santos Silva, 2256c.health Unipessoal LDA, Lisbon, Portugal.

Received: 03 December 2024; Accepted: 09 December 2024; Published: 23 December 2024

Citation: Inês dos Santos Silva, Luísa Soares, Frank Schifferdecker-Hoch. 7 Dimensions of Holistic Wellbeing (7DHW): A Theoretical Model. Archives of Internal Medicine Research. 7 (2024): 321-330.

Abstract

Keywords

Health and Behavior; Healthy Workplaces; Holistic Model of Wellbeing, Mental Health; Climate Change; Population Health

Article Details

1. Introduction

Wellbeing has become an increasingly prominent topic in both psychological and medical research in the public discourse, as it transcends traditional health paradigms by emphasizing a holistic view of an individual’s mental, physical, social, and spiritual dimensions. The World Health Organization (WHO) defines health as not merely the absence of disease but as a state of complete physical, mental, and social wellbeing [1, 2]. This definition has spurred a shift towards a holistic view of health, where wellbeing is understood as a complex, multi dimensional construct that integrates not only physical health but also psychological, social, and environmental factors [3]. Moreover, this expanded view of health has inspired various models that aim to capture the complex interrelations between different aspects of wellbeing, from self-esteem and body image to social relationships and the environment.

A holistic approach to wellbeing is particularly necessary in modern societies, where individuals are often exposed to various stressors that affect different aspects of their lives [4]. Brown et al. developed the Holistic Wellness Assessment [5] focused on the multiple dimensions that contribute to young adults’ wellness, underscoring the significance of a comprehensive perspective on health. Similarly, Kaveh et al. created the Perceived Wellness Survey (PWS), demonstrating the value of integrating physical and mental health indicators to understand overall wellness [6]. These frameworks highlight the importance of assessing wellbeing in a multi-dimensional context, where individual characteristics and external factors such as the environment and social support are deeply intertwined.

The importance of self-esteem and body image has been well-documented in literature as crucial components of mental and emotional wellbeing [7, 8]. Self-esteem, a stable sense of self-worth, forms the foundation for resilience and overall life satisfaction [9, 10, 11]. Body image, closely linked to self-esteem, plays a critical role in how individuals perceive themselves and their capacity for social interaction, contributing to either mental health or disorders like anxiety and depression [12, 13]. These dimensions, coordinated with the dimensions of meaningful work and social relationships, form interconnected pillars that support overall wellbeing.

A healthy and supportive environment contributes to the stability of these dimensions, reinforcing the individual’s ability to maintain physical and psychological health [14]. The validation of the Holistic Comfort Questionnaire in caregiver contexts further underscores the relevance of creating a supportive, caring environment for those experiencing stress and illness [15]. In addition, meaningful work has been shown to provide individuals with a sense of purpose, enhancing both self-esteem and long-term aspirations for the future [16]. The multi-dimensional wellbeing models reflect this synergy between internal and external factors, which offer a comprehensive view of health and its contributors.

This paper aims to develop and present a holistic model of wellbeing, organized around seven core dimensions: i) self-esteem, ii) body image, iii) social relationships, iv) environment, v) meaningful work, vi) health knowledge, and vii) a purpose and a sense of future. Each of these dimensions will be explored in terms of their interconnections and how they contribute to the overall wellbeing of individuals.

This model stands out by incorporating these seven specific dimensions identified as foundational to a person’s wellbeing. Unlike many existing models focusing on isolated factors, this model emphasizes the interplay among these dimensions, illustrating how internal and external factors dynamically contribute to holistic wellbeing [17, 3, 18, 19]. Furthermore, it aligns closely with the WHO’s definition of health, ensuring that the model reflects a comprehensive understanding of mental, physical, and social wellbeing.

This model significantly contributes to the field by offering a multi-dimensional, evidence-based framework encompassing key aspects of holistic health. It combines psychological, social, environmental, and occupational factors into a cohesive structure, aiming to inform research and practical approaches to wellbeing.

With the development of this theoretical model of wellbeing and all the research carried out in this study, we aim to answer the following research questions: (1) Is it possible to foster a theoretical model based on WHO guidelines? (2) Which dimensions are considered appropriate to include in this theoretical model?

2. Historical and Conceptual Background

Over the last century, the concept of wellbeing has undergone a substantial transformation, moving from a focus in medical terms predominantly on physical health to a more holistic approach that includes mental, social and environmental dimensions [20, 3, 1]. Early models of health, particularly in Western medicine, were rooted in the biomedical model, which viewed health primarily as the absence of disease or infirmity [21]. This perspective, dominant through the middle of the 20th century, emphasized pathology and physical health metrics, often leaving aside the psychological and social factors influencing wellbeing [22, 1].

The initial shift towards a more comprehensive view of health began with the work of early psychologists who highlighted the importance of mental health. An example is Sigmund Freud’s [23, 24] theories of psychoanalysis, which highlight the link between mental states and physical health, namely how unresolved psychological conflicts could manifest as physical symptoms. This idea of mind-body interdependence set the stage for understanding health as more than just a physical state [21, 25].

The humanistic psychology movement between the 1950s and 1960s, led by theorists such as Abraham Maslow [26, 27] and Carl Rogers [28, 29], further advanced this perspective. Maslow’s [26, 27] hierarchy of needs introduced a framework where self-actualization, social relationships, and personal growth were considered essential for overall wellbeing. Rogers [28, 29] emphasized the importance of a person-centered approach, where individuals are understood in the context of their environment and experiences. This movement marked a significant departure from purely medicalized views of health, incorporating a more holistic understanding of individual potential and satisfaction [30].

Simultaneously, sociologists began highlighting the importance of the social component in a person’s health.

Emile Durkheim’s [31, 32] work on social integration and mental health demonstrated how social factors, such as isolation or support systems, could influence mental health outcomes. This point marked the beginning of recognizing the social dimension of wellbeing [33], particularly how one’s social environment affects health [34].

In the 1970s, the Lalonde [35] Report from Canada further revolutionized public health by introducing the concept of ”health fields”. This concept categorized health determinants into four main fields: biology, environment, lifestyle, and healthcare. This model encouraged governments and health organizations to consider lifestyle and environmental factors as integral parts of an individual’s health, laying the groundwork for future holistic models [36, 37].

So WHO was instrumental in bolstering a holistic definition of health [1]. Its 1946 constitution described health as ”a state of complete physical, mental, and social wellbeing, and not merely the absence of disease or infirmity.” [1]. This definition, still widely referenced today, was revolutionary for its time, as it recognized mental and social health as equally important alongside physical health [38].

In the decades that followed the WHO definition [1], the field of public health began to adopt models that reflected these multidimensional aspects of health [39]. In 1970, Antonovsky [40, 41] introduced the concept of autogenesis, a model focused on factors that actively promote health rather than merely preventing disease. He proposed that an individual’s sense of coherence—characterized by a sense of comprehensibility, clarity, and meaningfulness in life—is essential to wellbeing. This approach broadened the understanding of health to incorporate resilience and adaptability, highlighting how individuals navigate and thrive in life’s challenges [42].

With the continued growth of the positive psychology movement in the 1990s, spearheaded by researchers like Martin Seligman [43], the field saw an increased focus on flourishing, happiness, and life satisfaction [44]. Positive psychology’s emphasis on constructs like meaning, purpose, and personal strengths aligned with holistic perspectives [45], recognising that true wellbeing involves thriving across multiple life domains, not just the absence of mental or physical health issues [19].

More recent holistic wellbeing models have further integrated dimensions such as environmental health, spirituality, and occupational satisfaction, acknowledging the interdependence of internal and external factors in fostering wellbeing [3, 18]. Ecological models [46], for example, have examined how the environment—from physical spaces to community dynamics—play a critical role in health, especially in urban areas where pollution, access to green spaces, and safe neighborhoods directly affect mental and physical wellbeing [47].

These cumulative advances have paved the way for contemporary multidimensional models of wellbeing that recognize the individual as a dynamic entity within a complex network of physical, social and psychological factors [48, 49]. Holistic models [17, 50], similar to the one presented in this paper, aim to encapsulate this comprehensive view by including dimensions such as self-esteem, meaningful work, social relationships, and the environment, all interlinked to provide a fuller picture of what it means to live a healthy, fulfilling life.

3. Dimensions of Holistic Wellbeing (7DHW): A Theoretical Model

The World Health Organization (WHO) states that health is ”a state of complete physical, mental and social wellbeing and not merely the absence of disease” [1, 2]. It suggests seven basic conditions that contribute to maintaining or restoring health (Figure 1):

• •  Self-Esteem - a stable self-esteem;
• •  Body Image - a positive perception of one’s own body;
• •  Social Relationships - friendship and good quality social relationships;
• •  Environment - an intact environment;
• •  Meaningful Work - meaningful work and healthy working conditions;
• •  Health Knowledge - health knowledge and access to health care;
• •  A Sense of Future - a present worth living in and a reasonable hope for a future worth living in.

Our model is built on the foundation of these seven interrelated core dimensions, each of which represents a key contributor to overall wellbeing. These dimensions are not just part of the model, but they are the model. They are the necessary ’pillars’ that support and maintain a healthy and balanced wellbeing. The dimensions reflect different aspects of holistic wellbeing and can be organized into a cohesive framework. This model captures the interconnected nature of the different dimensions contributing to overall wellbeing.

The term ”holistic” refers to a perspective that considers something as a whole rather than focusing on individual parts. In a holistic view, all aspects of a system or person are interconnected and interdependent, and understanding or treating the system requires looking at all components in relation to each other.

For example, in healthcare, an holistic approach would address not only physical symptoms but also mental, emotional, and social factors affecting a patient’s overall wellbeing. Similarly, in problem-solving or education, a holistic perspective involves understanding the broader context rather than isolated elements.

Figure 1: Seven dimensions of the theoretical model diagram.

3.1 Dimensions addressed and significance

All the dimensions adhered to in our model are related to various points of wellbeing, addressing physical, mental, social and spiritual wellbeing, and also include contextual factors, such as cultural, environmental and workplace influences, which can mediate the impact of each dimension of the model presented.

We will detail each dimension covered in the model, define it, determine the context in which it fits into the context of wellbeing, and determine how the various dimensions are linked together.

3.1.1 (A) Self-Esteem (A stable self-esteem)

Self-esteem refers to a stable and positive sense of self-worth and confidence. Self-esteem is foundational to psychological health, as individuals with stable self-esteem tend to be more resilient to external stressors [9]. Moreover, they are more likely to engage in positive behaviors that reinforce their overall wellbeing [10]. This dimension might influence or be influenced by other areas, such as meaningful work (E), body perception (B), and social relationships (C).

3.1.2 (B) Body Image (A Positive Perception of One’s Own Body)

The second dimension, Body Image, defines how a person perceives and feels about their physical appearance. A positive body perception contributes to mental health and self- acceptance [51]. Body Image issues can contribute to anxiety and depression, so positive perception is crucial [51]. This dimension can impact and be impacted by self-esteem (A) and social relationships (C).

3.1.3 (C) Social Relationships (Friendship and Good Quality Social Relationships)

Social Relationships are defined as the presence of strong, supportive social connec- tions and meaningful friendships [52]. They provide emotional support, reduce feelings of isolation, and are crucial for mental and emotional wellbeing [52, 53]. This dimension is likely closely tied to self-esteem (A), meaningful work (E), and the environment (D).

3.1.4 (D) Environment (An Intact Environment, free of human massive destruction)

The Environmental dimension refers to living in a healthy and stable environment without pollution, violence, or instability [54, 55, 56]. A clean and safe environment has a direct impact on physical health and an indirect impact on mental health, providing a sense of security [14]. The environment supports all the other dimensions. Moreover, good working conditions (E), social relationships (C) and self-perception (B) are likely to be affected by environmental conditions.

3.1.5 (E) Meaningful Work (Meaningful and Healthy Working Conditions)

Meaningful Work is defined as having a job that feels purposeful and is carried out in a healthy, supportive work environment [16]. Employment provides not just income but also a sense of identity and purpose. Work that aligns with personal values and is carried out in healthy conditions fosters wellbeing [57]. Meaningful work may directly impact self-esteem (A) and future aspirations (G) and is likely shaped by access to health knowledge (F) and environment (D).

3.1.6 (F) Health Knowledge (Knowledge and Access to Health Care)

Health Knowledge is the ability to access health care and the knowledge to make informed health decisions [58]. This dimension empowers individuals to take proactive steps to maintain physical and mental wellbeing [58, 59, 60, 61]. Access to healthcare ensures that individuals can address health issues promptly and effectively. Health knowl- edge not only supports other dimensions like body image (B) and work conditions (E) but also shapes future aspirations (G), inspiring individuals to strive for better health.

3.1.7 (G) A Sense of Future (A Present Worth Living In and Hope for a Future Worth Living In)

Sense of the Future refers to the feeling that the present is fulfilling and that the future holds hope and opportunities. This dimension reflects an individual’s optimism and satis- faction with life [62]. It is closely tied to long-term emotional health and wellbeing, helping individuals cope with challenges [63, 60]. This dimension is influenced by meaningful work (E), health knowledge (F), and social relationships (C).

3.2 The Interconnection of the 7 Dimensions

These seven dimensions—self-esteem, body image, social relationships, environment, meaningful work, health knowledge, and a sense of future—are interconnected in complex ways, each influencing and being influenced by the others. Let us break down these interactions:

1. Self-Esteem (A) is foundational to psychological health and resilience. A stable sense of self-worth directly impacts body image (B) because when individuals feel confident, they are more likely to have a positive perception of their physical appearance. Self-esteem also affects social relationships (C), as people who feel good about themselves tend to build healthier, more positive connections. Further- more, self-esteem can be bolstered by meaningful work (E), where engaging in purposeful work can reinforce a sense of value and identity.
2. Body Image (B), or how a person perceives their physical self, is closely tied to self-esteem, as a positive body image generally boosts one’s self-worth. Social relationships also impact body image because interactions with friends and family can shape how one feels about their appearance—positive support can improve body image, while negative interactions may harm it. Health knowledge (F), which includes understanding physical health and fitness, can reinforce a healthier body image as individuals become more informed about maintaining physical wellbeing.
3. Social Relationships (C) provide emotional support and a sense of belonging, which are critical for self-esteem. Good social connections can help individuals cope with challenges and reduce feelings of isolation. Social relationships are also shaped by and contribute to the environment (D), as a safe and positive physical environment fosters opportunities for socializing. Positive social relationships can also support career satisfaction in meaningful work (E) by reducing stress and fostering camaraderie.
4. Environment (D) profoundly impacts both physical and mental health, which in turn influences nearly every other dimension. For instance, a safe and healthy environment allows for stable self-esteem, as individuals feel secure and valued. The environment also impacts meaningful work (E); healthy, supportive workplaces improve job satisfaction and mental wellbeing. Likewise, social relationships (C) thrive in stable environments that facilitate positive interaction, and body image (B) may be influenced by cultural and environmental factors related to beauty standards or social norms.
5. Meaningful Work (E) gives individuals a sense of purpose, enhancing self-esteem and providing motivation. Having a job that aligns with personal values and is done in a healthy environment supports mental and physical wellbeing, linking directly to environment (D) and even social relationships (C) within the workplace. Meaningful work can shape future aspirations (G), inspiring individuals to pursue goals with optimism. At the same time, health knowledge (F) is also relevant, as awareness of health-promoting practices contributes to satisfaction and productivity at work.
6. Health Knowledge (F) empowers individuals to make informed decisions about their physical and mental health, impacting dimensions like body image (B) and meaningful work (E). A better understanding of health contributes to a positive body image as individuals make healthier choices. Health knowledge can also sup- port self-esteem by equipping people with the information to care for themselves and achieve wellbeing. Furthermore, it shapes future aspirations (G), as people informed about health are often more optimistic about their ability to maintain long-term wellness.
7. A Sense of Future (G), which is the hope for a fulfilling and meaningful life ahead, ties back to each of the other dimensions. People with a sense of meaningful work (E), positive social relationships (C), and good health knowledge (F) are more likely to feel hopeful about the future. This dimension also reinforces self-esteem, as a positive outlook on the future helps individuals cope with current stressors and challenges. The environment (D) also plays a role, as a stable environment fosters optimism and security regarding the future.

In summary, each dimension feeds into the others, creating a holistic network where improvements or declines in one area can ripple across the others. Addressing wellbeing in a balanced, comprehensive manner—rather than focusing on isolated aspects—can create lasting, positive impacts across an individual’s life.

4. Discussion and Comparative Analysis of Existing Models

As presented in this paper, developing a holistic model of wellbeing aims to capture the multifaceted nature of health by integrating dimensions that span psychological, social, and environmental aspects. This approach aligns with WHO’s definition of health [1] as a state of complete physical, mental, and social wellbeing, moving beyond a narrow focus on the absence of disease. Unlike existing models emphasizing isolated aspects of wellbeing [17], this model addresses the interplay among various dimensions—self-esteem, body image, social relationships, environment, meaningful work, health knowledge, and a sense of future—providing a dynamic and comprehensive view of health.

Comparatively, Ryff’s Six-Factor Model of Psychological Wellbeing [17] focuses on six psychological dimensions: autonomy, environmental mastery, personal growth, positive relations with others, purpose in life, and self-acceptance. While these elements are integral to wellbeing, they do not encompass the broader environmental and social factors that impact individuals daily. In contrast, the proposed model includes these external influences, acknowledging how social support, environmental stability, and meaningful employment interact with internal states to create a complete picture of wellbeing. Doing so reflects a more integrative understanding of the factors contributing to resilience and overall life satisfaction.

Similarly, the PERMA model [62, 43], proposed by Seligman within the positive psychology movement, emphasizes personal achievements and fulfilment through Positive Emotions, Engagement, Relationships, Meaning, and Accomplishments. While PERMA provides valuable insights into subjective wellbeing—an individual’s self-perceived quality of life and overall satisfaction [64, 65]—it does not explicitly account for health knowledge or environmental influences, which are important in understanding how individuals access resources and maintain a sense of physical security and wellness. Including dimensions like health knowledge and environmental concerns/information in the holistic model highlights its utility in public health and personal development contexts, offering a broader scope than PERMA’s psychological focus.

The Biopsychosocial Model [21, 66], developed by George Engel, marks a foundational shift toward a multidimensional view of health by incorporating biological, psychological, and social dimensions. While Engel’s model highlights the interconnectedness of these factors, the proposed holistic model goes further by incorporating dimensions that reflect individuals’ personal aspirations and quality of life, such as meaningful work and a sense of future. These additions bring a more aspirational aspect to the model, emphasizing survival and function, growth, purpose, and long-term wellbeing.

The model also draws from and builds on Lalonde’s Health Field Concept [67, 35], which categorizes health determinants into biology, environment, lifestyle, and healthcare. The proposed model’s dimensions, such as self-esteem and social relationships, provide fur- ther specificity, allowing for a deeper understanding of individual differences and unique life experiences. By detailing aspects of both personal and social life, this model expands on Lalonde’s broader categories, thereby improving its applicability in psychological, occu- pational, and social health settings.

Lastly, the ecological model of health [18, 68, 69] promotion emphasizes the importance of environmental influences on health. This perspective is incorporated into the holistic model by including the environment as a core dimension. However, the holistic model adds individual factors like self-esteem and body image, reflecting a more personalized view of wellbeing. This combination makes the model flexible and applicable across varied contexts, from individual therapy and community health interventions to organizational wellbeing programs.

In summary, this holistic model offers a distinct advantage over existing frameworks by emphasizing the interdependence of internal and external dimensions, thereby enabling a more nuanced understanding of wellbeing. It supports the point of view that health is not only influenced by personal psychological states or social circumstances but is also deeply affected by an individual’s sense of purpose, access to health knowledge, and environmental stability. By integrating these elements, the model contributes a comprehensive, adaptable approach to wellbeing, which can inform both academic research and practical applications in health promotion, therapy, and policy-making. Moreover, the proposed holistic model of wellbeing becomes a versatile tool that can be tailored to address the specific needs of populations facing unique physical, emotional, and social challenges. This flexibility underscores the model’s comprehensive nature and practical application in specialized healthcare, therapeutic, and occupational settings. Recent studies across diverse fields underscore the growing interest in wellbeing and quality of life for distinct groups [70], such as stroke survivors [71, 72, 73], cancer patients [74, 75, 76], or corporate employees

[77, 78, 79].

5. Conclusions and Further Studies

Currently, we are experiencing the impact of climate change on society and its conse- quences for health, so it is urgent to pay attention to health issues, particularly in cancer patients. The entire society must adapt to this ecological emergency by adopting more sus- tainable practices and becoming aware of the activities currently used in health contexts [56].

The objectives of the Europe 2030 Agenda also point to the importance of quality and sustainable health to reduce mortality and promote mental health and wellbeing, considering increasingly sustainable practices [80].

Additionally, Portugal’s health plan (2021-2030) [81] pays attention to sustainability in health in order to promote a healthy, resilient, fair and prosperous community and environments which safeguard the response to the needs of current populations, without compromising the future generations. Consequently, its objective is to reduce mortality and morbidity, the leading causes and risk factors. Furthermore, within the scope of sustainable development, several determinants for health are presented: (a) social, (b) economic, (c) environmental, (d) biological, (e) behavioral; (f) health care and (g) demographics, which are of unavoidable consideration.

Therefore, positive, and significant changes in behavior could be made sustainable by modifying habits to improve health and achieve goals in terms of environmental sustain- ability [80].

After research and data collection, we highlighted the existence of a vast scientific liter- ature on the topic. As for the investigation resulting from this new holistic model proposed in this work, we noted a gap regarding research connecting these seven dimensions, high- lighting the importance of future research focusing on this current issue and studying and opting for new research on this topic. In this logic, future research must understand how climate change influences people’s quality of life and its implications for their wellbeing. Furthermore, there is a need to provide information about the environmental impact to health professionals in this area and patients so that they can choose the least harmful options.

Additionally, it is essential to use assessment instruments and intervention programs adapted and validated for different populations that can validate this Theoretical Model of Seven Dimensions of Holistic Wellbeing (7DHW). Furthermore, it is essential to understand the need to look at health not only physical but also mental health, including in this view human working conditions, environmental knowledge about our planet and climate change, to plan interventions targeting people’s quality of life according to WHO guidelines [1, 2].

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