Original articleA critical enquiry into the psychometric properties of the professional quality of life scale (ProQol-5) instrument
Introduction
The concept of the measurement of ‘professional quality of life’ was first developed by Figley (1995) and Stamm (2010) continuing this work through the development of the Compassion fatigue and satisfaction test and more recently, the Professional Quality of Life Scale (ProQoL) Version 5. The scale measures ‘the quality one feels towards their work as a helper’ (Stamm, 2010, p. 8). There are two main aspects of quality of life: Compassion Satisfaction (CS) and Compassion Fatigue (CF). CF in turn is comprised of two concepts: secondary traumatic stress (STS) and burnout (BO). Based on hundreds of studies, the current instrument has been refined to measure compassion satisfaction and fatigue with the latter being composed of the constructs burnout and secondary traumatic stress, each being measured by a separate 10-item scale. A number of studies have used previous versions of the ProQoL and cited psychometric properties performed on data obtained from health professionals in general (AIHW, 2013, Huggard and Dixon, 2011, Stamm, 2010). These were also cited in nursing studies such as a study on nursing staff at a forensic security unit in Norway (Lauvrud et al., 2009a, Lauvrud et al., 2009b) and an American study on oncology nurses (Potter et al., 2010). Nevertheless, for the most part, the Proqol scale has been adopted and used as a tool (e.g., Beaumont et al., 2016, Burnett and Wahl, 2015, Chan et al., 2015, Dasan et al., 2015, Yoder, 2010) rather than critically analysing the instrument and thus the literature could benefit from more studies focusing on psychometric properties analysis of this scale. For example, although a recent study on nurses in Latvia has presented a limited psychometric properties analysis of version 5 (Circenis, Millere, & Deklava, 2013), other studies on palliative care workers have highlighted the need for more psychometric property analysis of ProQol 5 (Galiana et al., 2017, Samson et al., 2016, Watts and Robertson, 2015).
Thus, the objectives of this study are to determine using multiple datasets 1) the psychometric properties of the three ProQoL 5 scales (BO, CS and STS) and 2) whether the three-factor structure of the instrument fit the three datasets collected 3) and if each of the items perform well in measuring their associated constructs and make the appropriate recommendations. In doing so, this study conducts a comprehensive psychometric property analysis on the basis of three datasets from nurses and palliative care workers in Canada and Australia to allow for comparisons and to ensure that findings were not the result of specific characteristics of one sample.
ProQol 5 is a widely applied measure of quality of life developed by Stamm (2010) and is comprised of two components: Compassion Satisfaction and Compassion Fatigue. Compassion Satisfaction is defined as the positive feelings one has about one's professional work – the satisfaction a person receives through their work as a helper (Stamm, 2010). In contrast, CF is considered to be the negative aspects of care provision. Stamm's model of CF is comprised of two concepts: secondary traumatic stress (STS) and burnout. In contrast to Post Traumatic Stress Disorder (PTSD), which develops from a primary trauma, and is a diagnosable psychological disorder, STS is considered to be a consequence for carers and health professionals frequently exposed to the stress and trauma of others (Boyle, 2011, Radey and Figley, 2007). STS may include sleep difficulties due to anxiety and intrusive images, avoidance of reminders of a person's traumatic experience, and cognitive emotional symptoms similar to those of the person that has been traumatized (Figley, 1995). On the other hand, burnout is a work-related stress symptom and is associated with depersonalisation, emotional exhaustion, and an inability to work effectively (Maslach et al., 2001, Stamm, 2010). While many studies have adopted ProQol 5 (e.g., Hunsaker et al., 2015, Lauvrud et al., 2009a, Lauvrud et al., 2009b, Yadollahi et al., 2016) few have conducted a comprehensive psychometric analysis of this scale. One such study is that of Galiana et al. (2017) examining palliative care workers in Spain and Brazil, in which the utilized confirmatory factor analysis did not fit well, and three items across two different scales did not load on their appropriate construct, in addition, concerns were reported on reliability of the BO scale. Another study by Samson et al. (2016) on Israeli palliative care workers highlighted the need for more research on BO and STS where confirmatory factor analysis did not fit well. Their study suggests appropriateness of a shorter version of ProQol. However no study has been found that comprehensively examined the range of psychometric properties (e.g., composite reliability, convergent validity, discriminant validity). Subsequently, this body of research could benefit from an in-depth analysis of the psychometric properties of ProQol 5, especially using multiple datasets across countries and types of caregivers to establish the extent to which the ProQol 5 is a valid and reliable instrument for research.
The Professional Quality of Life Scale version 5 (ProQoL 5), (Stamm, 2010) measures levels of CS and CF with the latter concept being composed of burnout and STS. The ProQoL 5 instrument, measures each of these three constructs using three 10, 5-point items (1 – never to 5 – very often) scales (thus, 30 items in the ProQol instrument). Respondents are asked to read each statement in relation to their current work situation and select the number that reflects how “frequently they experienced these things in the last 30 days”. Sample items include: CS - “I feel invigorated after working with those I [help]”; Burnout – “I feel worn out because of my work as a [helper]”; STS – “I feel as though I am experiencing the trauma of someone I have [helped]”. Although the ProQoL was originally developed for emergency personnel and trauma counsellors, the scale has been utilized internationally for various target populations (Stamm, 2010).
Although the focus of this article is on the ProQoL 5, an additional measure, the Depression Anxiety Stress scale (DASS) was utilized (collected only in the Australian and Canadian studies) to establish construct validity.
Depression Anxiety Stress Scales (DASS) (Lovibond & Lovibond, 2004) is a survey instrument used to measure of general negative mood symptoms over the past week. The DASS21 was used in this study and is a 21-item version of the longer 42-item DASS. The DASS contains three scales: depression, anxiety and stress. Participants are asked to rate each statement on a 4-point scale (0 – not at all, to 3 – very much/most of the time). Sample scale items include: depression – “I felt down-hearted and blue”; anxiety – “I felt scared without any good reason”; stress – “I tended to over-react to situations”. Each scale is summed to obtain a full-scale score for the respective scale. The DASS and DASS21 have demonstrated high internal consistency and strong psychometric properties in both normal and clinical populations (Antony et al., 1998, Brown et al., 1997, Lovibond and Lovibond, 2004).
Section snippets
Method
Three independently gathered datasets from two counties (Australia and Canada) and two respondent populations (nurses and palliative caregivers) were used to test the psychometric properties of the ProQol 5. Each dataset was part of a larger study. Multiple datasets were utilized to increase generalizability of results (country and type of worker) to ensure that findings were not particular to a single dataset. Information on data collection and demographics of each of the three samples is
Australian nurses dataset
The BO scale had an average inter-item correlation of = .30 with 35 of 45 inter-item correlations significant and 6 of the remaining 10 showing a strong trend (one-tailed significant and p < .10); the remaining 4 being not significant. The CS scale had all significant inter-item correlations with an average inter-item correlation of = .47.
The STS scale had an average inter-item correlation of = .32 with 40 of 45 inter-item correlations being significant and two showing a strong trend
Discussion and conclusion
Professional quality of work life is an important topic for caregiver research with the most utilized instrument for measurement of this being the ProQol (Stamm, 2010) which measures respondent's levels of compassion satisfaction and compassion fatigue (composed of burnout (BO) and secondary trauma stress (STS)). With increasing restriction of resources and the greater reliance on non-full time caregivers, levels of stress, uncertainty and potentially quality of patient care is of concern. High
Compliance with ethical standards
Funding: The Australian study was funded internally by Sir Charles Gairdner Hospital, Perth, Western Australia. The Canadian Institutes of Health Research funded the Canadian Palliative Care study and an Internal Grant at Nipissing University funded the Canadian Nurses study.
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