Factor structure of the Maslach Burnout Inventory Human Services Survey in Spanish urgency healthcare personnel: a cross-sectional study

(2022) 22:615 Forné and Yuguero BMC Medical Education https://doi.org/10.1186/s12909-022-03666-3 Open Access RESEARCH Factor structure of the Maslach Burnout Inventory Human Services Survey in Spanish urgency healthcare personnel: a cross‑sectional study Carles Forné1,2*†   and Oriol Yuguero3,4*†    Abstract Background: The Maslach Burnout Inventory (MBI) is an instrument commonly used to evaluate burnout syndrome. The goal of the present study was to assess the internal reliability and the performance of the items and the subscales of the MBI-HSS (the version for professionals working in human services) by validating its factorial structure in Spanish urgency healthcare personnel. Methods: Cross-sectional study including 259 healthcare emergency professionals (physicians and nurses) in the Spanish health region of Lleida and the Pyrenees. Burnout was measured using the Spanish validated version of the MBI-HSS. Internal reliability was estimated using Cronbach’s alpha coefficient. The sampling adequacy was assessed using the Kaiser-Meyer-Olkin measure along with the Bartlett’s test of sphericity. A principal axis exploratory factor analysis with an oblique transformation of the solution and a confirmatory factor analysis with maximum likelihood estimation were performed. Goodness-of-fit was assessed by means of the chi-square ratio by the degrees of freedom, the standardized root mean square residual (SRMR), the root mean square error of approximation (RMSEA), the Tucker-Lewis Index (TLI) and the comparative fit index (CFI). Results: The three subscales showed good internal reliability with Cronbach’s alpha coefficients exceeding the critical value of 0.7. Exploratory factor analysis revealed five factors with eigenvalues greater than 1. Nevertheless, confirmatory factor analysis showed a relatively satisfactory fit of the three-factor structure (χ2/df = 2.6, SRMR = 0.07, RMSEA = 0.08, TLI = 0.87, CFI = 0.89), which was improved when several items were removed (χ2/df = 1.7, SRMR = 0.04, RMSEA = 0.05, TLI = 0.97, CFI = 0.98). Conclusions: Although it is necessary exploring new samples to get to more consistent conclusions, the MBI-HSS is a reliable and factorially valid instrument to evaluate burnout syndrome in health professionals from the Spanish emergency services. † Carles Forné and Oriol Yuguero contributed equally to this work. *Correspondence: ; ; 1 Department of Health Economics and Outcomes Research, Heorfy Consulting, Lleida, Spain 3 Emergency Service, University Hospital Arnau de Vilanova, Av. Alcalde Rovira Roure 80, 25198 Lleida, Spain Full list of author information is available at the end of the article © The Author(s) 2022. 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The Creative Commons Public Domain Dedication waiver (http://creativeco mmons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Forné and Yuguero BMC Medical Education (2022) 22:615 Page 2 of 10 Keywords: Burnout, Psychological, Factor Analysis, Statistical, Maslach Burnout Inventory – Human Services Survey, Emergencies, Psychometrics Background In recent decades, professional burnout among health professionals has become a topic of great interest for researchers around the world; partly due to the great burden on the national health systems and on society in general. The effects resulting from burnout have proven to cause issues in workers’ physiological (e.g., cardiovascular diseases) and psychological (e.g., mental disorders) conditions, and affecting their performance at work (e.g., increased dissatisfaction, absenteeism and presenteeism) [1]. Introduced by Freudenberger, staff burnout is a state of mental, emotional, and physical exhaustion that occurs as a result of overwhelming demands, chronic stress, or job dissatisfaction [2]. Maslach later provided a comprehensive definition of the term involving emotional exhaustion (EE), depersonalization (DP), and a reduced sense of personal accomplishment (PA) that can occur among individuals who work with people in some way [3]. Thus, EE assesses feelings of being emotionally overwhelmed and exhausted by one’s work; DP measures a callous and impersonal response toward recipients of one’s service, care or treatment; and PA assesses feelings of competence and successful achievement in one’s work. The definition provided by Maslach led to the subsequent identification of these three main dimensions of burnout evaluated through the Maslach Burnout Inventory (MBI) [4, 5]. Other several instruments exist to measure job-related burnout in human service professionals. Among these are the Staff Burnout Scale [6, 7] and the Burnout Measure [8]. By far, the MBI is the worldwide leading instrument for assessing burnout. As Schaufeli et al. [9] pointed out, the success of the MBI may lie in the work of Perlman and Hartman [10], who after a review of more than 48 definitions of the burnout syndrome concluded that burnout should be defined as “a response to chronic emotional stress with three components: (a) emotional and/or physical exhaustion, (b) lowered job productivity, and (c) overdepersonalization.” This definition was very similar to the one proposed by Maslach and Jackson [4, 5] as a result of factoring the MBI, and probably generalized its use and acceptance. Currently, there are three versions of the MBI: the General Survey (MBI-GS), used for workers in general; the Educators Survey (MBI-ES), used in the educational area; and the Human Services Survey (MBI-HSS), used for the health services [11]. Several studies have been published carrying out exploratory and/or confirmatory analyses of the factorial structure of the MBI in different professional groups [12]. Although the studies carried out with health professionals have focused mainly on nursing professionals, both emergency and non-emergency nursing care [13, 14], even exploring differences between countries [15], there are also some studies including physicians [16], and including all emergency professional profiles [17]. But we are not aware of any study exploring the factorial validity of the MBI-H (...truncated)