Psychometric properties of the moral injury symptom scale among Chinese health professionals during the COVID-19 pandemic

BackgroundMoral 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.MethodsA 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.ResultsCronbach's alpha 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).ConclusionsThe 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.