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. 2020 Oct 20;8(1):109.
doi: 10.1186/s40359-020-00477-3.

Stress of Conscience Questionnaire (SCQ): exploring dimensionality and psychometric properties at a tertiary hospital in Australia

Yangama Jokwiro  1   2 , Elizabeth Pascoe  3 , Kristina Edvardsson  3 , Muhammad Aziz Rahman  4 , Ewan McDonald  3 , Qarin Lood  3   5 , David Edvardsson  3   6
Affiliations

Stress of Conscience Questionnaire (SCQ): exploring dimensionality and psychometric properties at a tertiary hospital in Australia

Yangama Jokwiro et al. BMC Psychol. .

Abstract

Background: This study explored the psychometric properties and dimensionality of the Stress of Conscience Questionnaire (SCQ) in a sample of health professionals from a tertiary-level Australian hospital. The SCQ, a measure of stress of conscience, is a recently developed nine-item instrument for assessing frequently encountered stressful situations in health care, and the degree to which they trouble the conscience of health professionals. This is relevant because stress of conscience has been associated with negative experiences such as job strain and/or burnout. The validity of SCQ has not been explored beyond Scandinavian contexts.

Methods: A cross-sectional study of 253 health professionals was undertaken in 2015. The analysis involved estimates of reliability, variability and dimensionality. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used to explore dimensionality and theoretical model fit respectively.

Results: Cronbach's alpha of 0.84 showed internal consistency reliability. All individual items of the SCQ (N = 9) met the cut-off criteria for item-total correlations (> 0.3) indicating acceptable homogeneity. Adequate variability was confirmed for most of the items, with some items indicating floor or ceiling effects. EFA retained a single latent factor with adequate factor loadings for a unidimensional structure. When the two-factor model was compared to the one-factor model, the latter achieved better goodness of fit supporting a one-factor model for the SCQ.

Conclusion: The SCQ, as a unidimensional measure of stress of conscience, achieved adequate reliability and variability in this study. Due to unidimensionality of the tool, summation of a total score can be a meaningful way forward to summarise and communicate results from future studies, enabling international comparisons. However, further exploration of the questionnaire in other cultures and clinical settings is recommended to explore the stability of the latent one-factor structure.

Keywords: Dimensionality; Exploratory factor analysis and confirmatory factor analysis; Health professionals; Psychometrics; Stress of conscience.

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Conflict of interest statement

The authors declare no potential competing interest with respect to the research, authorship, and publication of this article.

Figures

Fig. 1
Fig. 1
Confirmatory Factor Analysis (CFA) of the one-factor structure proposed in this study using AMOS software. SCQ = Stress of Conscience Questionnaire. SCQ 1 to 9 = Stress of Conscience Questionnaire Index Score Items (Part A multiply by Part B of each item). CFA identifying variance was 1 and factor loading cut-off was set > 0.4
Fig. 2
Fig. 2
Confirmatory Factor Analysis (CFA) of the two-factor structure proposed by Glasberg et al. (2006) using AMOS software. SCQ = Stress of Conscience Questionnaire. SCQ 1 to 9 = Stress of Conscience Questionnaire Index Score Items (Part A multiply by Part B of each item). CFA identifying variance was 1 and factor loading cut-off was set > 0.4
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