The psychometric properties of the Persian version of the moral injury symptoms scale-health care professionals version

Abstract

BackgroundHealth care professionals face a number of problems during crises, such as the COVID-19. Studies addressed the prevalence of moral injury among healthcare professionals during the COVID-19 outbreak. Lack of a valid standard of moral injury among health care professionals is one of the factors that has made it difficult to identify and treat this complication. This study aimed to evaluate the psychometric properties of the Moral Injury Symptoms Scale-Health Care Professionals (MISS-HP) among health care professionals in Iran.MethodsThis study was conducted to evaluate the validity and reliability of the MISS-HP. The sample included 455 healthcare professionals working in four teaching hospitals in Kerman, who were in direct contact with patients. In this study, face validity, content validity, construct validity (structural and convergent), and internal reliability of the MISS-HP were evaluated. Demographic information questionnaire, the Moral Injury Symptoms Scale-HealthCare Professionals (MISS-HP), General Health Questionnaire (GHQ), and Impact of Event Scale (IES) were administered to study participants.ResultsThe MISS-HP was evaluated using translation-back translation technique. The content validity index of the items (I-CVI) and the scale (S-CVI) were 0.9 and 0.99, respectively. Exploratory factor analysis showed a three-factor structure in the MISS-HP that explained 57.49% of the variance. Confirmatory factor analysis indices were acceptable. The cut-off point of the questionnaire was 36.5. There was a positive and moderate correlation between the Persian version of MISS-HP, GHQ (r = 0.34), and IES-R (r = 0.40). The Cronbach’s alpha coefficient of the Persian version of MISS-HP was 0.70.ConclusionThis study found that the MISS-HP is a concise, comprehensive, valid and reliable scale for assessing moral injury among health care professionals in clinical or research settings. This scale will be helpful for managers and researchers to identify and plan health policies and improve the psychological state of health care professionals.

Prevalence of occupational moral injury and post-traumatic embitterment disorder: a systematic review and meta-analysis

“…The PRISMA flowchart delineates the review process (see figure 1). Of the 81 full texts included in the review,6 12–21 43–112 some reported multiple studies in the same paper, so there were 88 separate studies included in the review. Of these, six reported prevalence estimates or average scores that could not be pooled, so they were included in the narrative synthesis only.…”

“…The number of items and scoring is based on the typical use of the scale.*Some papers modified the Likert scale and used a cut-off of 3+ ‘sometimes’ and 4+ ‘often’51 or 3+ ‘agree’ 70 90†The German MISS-HP (G-MISS-HP) uses a 9 item scale with a cut-off>28.5,107 The Persian MISS-HP uses a cut-off>36.5 92‡PMIE questions precede the MIOS symptoms scale and can be quantified as endorsed (yes/no).AoW, Atrocities of War; BMIS, Brief Moral Injury Screen; EMIS-M, Expressions of Moral Injury Scale-Military Version; EMIS-SF, Expressions of Moral Injury Scale-Short Form; LFB, Leadership Failure or Betrayal; MIA-PSP, Moral Injury Assessment for Public Safety Personnel; MIES, Moral Injury Events Scale; MIOS, Moral Injury Outcome Scale; MIQ-M, Moral Injury Questionnaire—Military version; MIQ-T, Moral Injury Questionnaire—Teacher version; MISS-HP, Moral Injury Symptoms Scale—Health Professionals; PCoW, Psychological consequences of War; PTED, post-traumatic embitterment disorder.…”

“… †The German MISS-HP (G-MISS-HP) uses a 9 item scale with a cut-off>28.5, 107 The Persian MISS-HP uses a cut-off>36.5. 92 …”

Validity evaluation of the Health Information Preferences Questionnaire among college students

“…The factor loadings, representing how well each item correlates with its underlying dimension, demonstrated strong convergent validity (CR values >0.7). Convergent validity, confirmed by high CR values and significant eigenvalues (indicating the variance captured by a factor), ensures that the dimensions accurately reflect the constructs they are intended to measure ( 41 , 42 ). Our factor analysis led to the removal of certain items, a decision aimed at enhancing the HIPQ’s construct clarity.…”