Translation and validation of the “Moral Injury Symptom Scale-Healthcare Professionals” in Greek

Abstract

Abstract Background Stressful events occur several times during work among healthcare professionals. Especially, during the COVID-19 pandemic, healthcare professionals have had to deal with a variety of ethical dilemmas causing high levels of moral injury. Aim To translate and validate the “Moral Injury Symptom Scale-Healthcare Professionals” (MISS-HP) in Greek. Methods We conducted our study with 345 nurses in Greece during August 2023. We employed the forward-backward method to translate the MISS-HP in Greek. We examined the construct validity of the MISS-HP by performing confirmatory factor analysis. We estimated concurrent validity of the MISS-HP by comparing it with the “Moral Distress Thermometer” (MDT), the “Quiet Quitting Scale” (QQS), and single item burnout measure. Results We found that the MISS-HP had exceptional reliability since all intraclass correlation coefficients in test-rest reliability analysis were higher than 0.990. Moreover, all correlations were statistically significant (p < 0.001 in all cases). Additionally Cronbach’s coefficient alpha for the MISS-HP was 0.636. Our CFA confirmed the three-factors structure of the Greek version of the MISS-HP: guilt/shame factor, spiritual troubles factor, and condemnation factor. All model fit indices in CFA were excellent. In particular, x2/df was 1.316, RMSEA was 0.030, GFI was 0.979, AGFI was 0.959, TLI was 0.975, IFI was 0.985, NFI was 0.939, and CFI was 0.984. We found that the concurrent validity of the Greek version of the MISS-HP was very good. In particular, we found statistically significant correlations between the MISS-HP and MDT (r = 0.46, p < 0.001), QQS (r = 0.41, p < 0.001), and the single item burnout measure (r = 0.11, p < 0.04). Conclusions The “Moral Injury Symptom Scale-Healthcare Professionals” is a reliable and valid tool to measure moral injury among healthcare professionals.