Sexually Harassing Behaviors from Patients or Clients and Care Workers’ Mental Health: Development and Validation of a Measure

Abstract

Although evidence reveals severe effects of sexual harassment on care workers’ mental health, there is a scarcity of studies that investigate care workers’ experiences of sexually inappropriate behavior from patients or clients. One reason for this lack of research is that validated measures that assess different types of sexual harassment experienced by employees working with patients or clients are lacking. In this study, we seek to establish a conceptual framework for investigating extraorganizational sexual harassment in healthcare work. Based on this theoretical framework, we developed and validated a measure for assessing sexually harassing behaviors from patients or clients. Data were gathered from heterogeneous samples of employees working in a variety of settings in healthcare. To evaluate the factorial structure of the measure, we conducted exploratory factor analysis (EFA) using a calibration sample (N = 179) and confirmatory factor analysis (CFA) using a cross-validation sample (N = 305). The construct validity of the measure was demonstrated by investigating relationships with indicators of care workers’ mental health. EFA revealed three factors, namely, nonverbal, verbal, and physical acts of sexual harassment. Examination of the measure comprising 14 items revealed acceptable internal consistencies and substantial correlations with indicators of care workers’ mental health. This study provides a useful and sound measure for assessing sexual harassment from patients or clients and paves the way for the development of a comprehensive theoretical framework for the assessment of sexual harassment. Furthermore, it facilitates future investigations of risk factors for sexual harassment and protective factors helping healthcare workers cope with sexual harassment from patients or clients.

Sexual Harassment by Patients, Clients, and Residents: Investigating Its Prevalence, Frequency and Associations with Impaired Well-Being among Social and Healthcare Workers in Germany

“…Relative to other industries, the healthcare workforce is even more at risk of experiencing sexual harassment by people outside the organization (e.g., patients and clients) [ 7 , 8 ]. Research in the field of sexual harassment by patients, clients or residents is fragmented and fraught with problems [ 9 ], especially due to the lack of a valid assessment of this phenomenon. A major challenge is that meaningful prevalence rates are lacking.…”

“…The individual assessment of the harassed person is prioritized, regardless of whether the harassing behavior is intentional or unintentional. Sexual harassment in the workplace is a multifaceted phenomenon that covers a wide range of nonverbal, verbal, and physically inappropriate sex-related behaviors at work [ 2 , 7 , 9 , 16 , 17 ]. Examples of nonverbal sexual harassment are sexualized gestures or acts, and examples of verbal sexual harassment are unwanted sexualized comments or jokes [ 7 ].…”

“…However, it remains unclear which form of sexual harassment (nonverbal, verbal, or physical) occurs. Existing studies have often focused on verbal and physical sexual harassment while often disregarding nonverbal aspects of sexual harassment [ 9 ]. The study by Vincent-Höper and colleagues [ 9 ] provided initial evidence that all three forms of sexual harassment by patients, clients, and residents occur in social and healthcare facilities in Germany.…”

“…Existing studies have often focused on verbal and physical sexual harassment while often disregarding nonverbal aspects of sexual harassment [ 9 ]. The study by Vincent-Höper and colleagues [ 9 ] provided initial evidence that all three forms of sexual harassment by patients, clients, and residents occur in social and healthcare facilities in Germany. However, in the few existing studies that have focused on the prevalence of sexual harassment by patients, clients, and residents, unvalidated scales or single-item measures have been used (e.g., “Have you been exposed to sexual harassment at your workplace during the last 12 months?”).…”

“…The use of single-item measures faces various problems. For example, the answer to direct questions about sexual harassment could depend upon the respondents’ implicit definitions of sexual harassment and might result in an underestimation of prevalence rates [ 9 ]. A reason behind this might be that people are reluctant to label sexually inappropriate behaviors as sexual harassment [ 23 ] because being a victim of sexual harassment is associated with stigmatization and weakness.…”