Psychometric Properties of the Serbian Version of the Maslach Burnout Inventory-Human Services Survey: A Validation Study among Anesthesiologists from Belgrade Teaching Hospitals

Hindawi Publishing Corporation e Scientific World Journal Volume 2015, Article ID 903597, 8 pages http://dx.doi.org/10.1155/2015/903597 Research Article Psychometric Properties of the Serbian Version of the Maslach Burnout Inventory-Human Services Survey: A Validation Study among Anesthesiologists from Belgrade Teaching Hospitals Bojana MatejiT,1 Miodrag MilenoviT,2 Darija KisiT TepavIeviT,3 Dušica SimiT,4 Tatjana PekmezoviT,3 and Jody A. Worley5 1 Institute of Social Medicine, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia Center for Anesthesiology and Resuscitation, Emergency Center, Clinical Center of Serbia, 11000 Belgrade, Serbia 3 Institute of Epidemiology, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia 4 University Children’s Hospital, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia 5 Department of Human Relations, University of Oklahoma, Oklahoma City, OK 73019, USA 2 Correspondence should be addressed to Bojana Matejić; Received 23 February 2015; Revised 2 May 2015; Accepted 3 May 2015 Academic Editor: Javier Garcia Campayo Copyright © 2015 Bojana Matejić et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. We report findings from a validation study of the translated and culturally adapted Serbian version of Maslach Burnout InventoryHuman Services Survey (MBI-HSS), for a sample of anesthesiologists working in the tertiary healthcare. The results showed the sufficient overall reliability (Cronbach’s 𝛼 = 0.72) of the scores (items 1–22). The results of Bartlett’s test of sphericity (𝜒2 = 1983.75, df = 231, 𝑝 < 0.001) and Kaiser-Meyer-Olkin measure of sampling adequacy (0.866) provided solid justification for factor analysis. In order to increase sensitivity of this questionnaire, we performed unfitted factor analysis model (eigenvalue greater than 1) which enabled us to extract the most suitable factor structure for our study instrument. The exploratory factor analysis model revealed five factors with eigenvalues greater than 1.0, explaining 62.0% of cumulative variance. Velicer’s MAP test has supported fivefactor model with the smallest average squared correlation of 0,184. This study indicated that Serbian version of the MBI-HSS is a reliable and valid instrument to measure burnout among a population of anesthesiologists. Results confirmed strong psychometric characteristics of the study instrument, with recommendations for interpretation of two new factors that may be unique to the Serbian version of the MBI-HSS. 1. Introduction Burnout is defined as a syndrome of emotional exhaustion, depersonalization, and reduced personal accomplishment that is experienced in response to chronic job stressors that can occur in any kind of occupation, but mostly among human service professionals [1]. Numerous studies have confirmed that physicians and nurses experience very high levels of burnout, dissatisfaction, and work-related stress [2–4]. Burnout contributes to poor health outcomes of health care professionals, both in terms of physical illness and emotional problems [5]. This is followed by significant professional consequences (decreased work activity and demotivation, absence, impaired efficiency, impairment of relationships with other members of the health team, and high turnover intention rate) [6, 7], influencing the quality of care [8], patient satisfaction [9], and patient compliance [10]. The prevalence and severity of professional burnout have been reported across different medical specialties but most of the investigations explored the effects of work stress and burnout among intensive care unit professionals [11– 13]. Previous studies have shown that anesthesiology is one of the most stressful specialties in medicine and can be associated with an increased risk of developing burnout 2 syndrome among employees [14, 15]. The application of modern, invasive diagnostic, and therapeutic procedures and the introduction of increasingly complex medical technologies in the operating rooms and intensive care units significantly push the boundaries of patient survival but impose a more rigorous professional standard for employees. An interdisciplinary approach to treatment requires constant improvement of theoretical knowledge and skills and more complex work of anesthesiologists. The risk of developing occupational burnout is especially high for anesthesiologists responsible for the management and organization of the service [15, 16]. The most widely used instrument to measure burnout among healthcare professionals is the MBI-HSS (Maslach Burnout Inventory-Human Services Survey). A review of 34 burnout studies [17] in addition to results from other recent studies on the psychometric proprieties of MBI-HSS provides considerable evidence supporting the use of the Maslach Burnout Inventory-HSS as a useful measurement instrument for occupational burnout across a wide range of occupations, languages, and countries [18–20]. However, a commercial version of the MBI-HSS does not currently exist in Serbia. There are no known psychometric studies that have analyzed the factor structure of this instrument for a Serbian population. The use of the English version of the MBI-HSS with Serbian samples suggests the potential value of a Serbian language version of the MBI and demonstrates a desire to evaluate the burnout syndrome at work in the population of people whose primary language is Serbian. Moreover, the MBI has some known psychometric limitations that warrant caution in the use of the English version with populations for whom English is not the primary language [21]. This study is a first step toward the adaptation and validation of the MBI-HSS for use with Serbian speaking population. There is a paucity of research on occupational burnout syndrome in the Serbian population. Existing studies of burnout have attempted to measure the construct with the English version of the instrument [22–26]. However, none of these studies present a psychometric evaluation of the instrument that was used to measure burnout. Psychometric studies on the factor structure of the MBI-HSS or the original MBI—to which the MBI-HSS corresponds—began in the 1980s and the early 1990s with exploratory factor analysis (EFA) or principal components analysis (PCA). Confirmatory factor analysis (CFA) is now commonly used for testing hypothesized models of factorial validity after the fundamental factor structure is established. A consistent finding with English translations is that the model fit for the original 22-item MBI-HSS (MBI-HSS-22) is poor (e.g., [27, 28]). In some studies, this problem was addressed by accepting correlations between the residual variances in the model and by allowing items to load across several factors in the tested model (e.g., [27]). There (...truncated)