Department of Research, Futian Center for Chronic Disease Control, #9 Xinsha Road, Shenzhen, 518000, People's Republic of China.
Department of Epidemiology and Health Statistics, School of Public Health and Management at Ningxia Medical University, Yinchuan, 750004, People's Republic of China.
BMC Psychiatry. 2020 Nov 25;20(1):556. doi: 10.1186/s12888-020-02954-w.
Moral injury among physicians and other health professionals has attracted attention in the mainstream literature, this study aim to assess the psychometric properties of the 10-item Moral Injury Symptoms Scale-Health Professional (MISS-HP) among healthcare professionals in China.
A total of 583 nurses and 2423 physicians were recruited from across mainland China. An online survey was conducted from March 27 to April 26, 2020 (during the middle of the COVID-19 pandemic) using the Chinese version of the MISS-HP. Reliability was assessed by internal consistency reliability and test-retest reliability. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were performed to determine scale structure.
Cronbach's α of the scale for both samples was acceptable (0.71 for nurses and 0.70 for physicians), as was test-retest reliability (ICCs for the individual items ranged from 0.41 to 0.74, with 0.77 for the overall scale in physicians). EFA suggested three factors, and the CFA indicated good fit to the data. Convergent validity was demonstrated with the 4-item Expressions of Moral Injury Scale (r = 0.45 for physicians, r = 0.43 for nurses). Discriminant validity was demonstrated by correlations with burnout and well-being (r = 0.34-0.47), and concurrent validity was suggested by correlations with depression and anxiety symptoms (r = 0.37-0.45). Known groups validity was indicated by a higher score in those exposed to workplace violence (B = 4.16, 95%CI: 3.21-5.10, p < 0.001).
The MISS-HP demonstrated acceptable reliability and validity in a large sample of physicians and nurses in mainland China, supporting its use as a screening measure for moral injury symptoms among increasingly stressed health professionals in this country during the COVID-19 pandemic.
医生和其他卫生专业人员的道德伤害已引起主流文献的关注，本研究旨在评估中文版医护人员道德伤害症状量表-卫生专业人员版（MISS-HP）在中国大陆卫生保健专业人员中的心理测量特性。
共招募了来自中国大陆各地的 583 名护士和 2423 名医生。2020 年 3 月 27 日至 4 月 26 日（COVID-19 大流行期间）使用中文版 MISS-HP 进行了在线调查。采用内部一致性信度和重测信度评估信度。进行探索性因子分析（EFA）和验证性因子分析（CFA）以确定量表结构。
两个样本量表的克朗巴赫 α 值均为可接受（护士为 0.71，医生为 0.70），重测信度也可接受（医生各条目 ICC 范围为 0.41 至 0.74，总体量表为 0.77）。EFA 提示存在三个因素，CFA 表明数据拟合良好。与 4 项道德伤害表达量表（医生 r=0.45，护士 r=0.43）的相关性表明具有聚合效度。与倦怠和幸福感（r=0.34-0.47）的相关性表明具有判别效度，与抑郁和焦虑症状（r=0.37-0.45）的相关性表明具有同时效度。暴露于工作场所暴力的人群得分较高表明具有已知群体效度（B=4.16，95%CI：3.21-5.10，p<0.001）。
MISS-HP 在中国大陆较大的护士和医生样本中表现出可接受的信度和效度，支持其在 COVID-19 大流行期间该国压力越来越大的卫生专业人员中作为道德伤害症状的筛查措施使用。
