Italian validation of the Measure of Moral Distress for Healthcare Professionals (MMD-HP): A multicenter cross-sectional study

Abstract

Background

Moral distress occurs when ethically appropriate actions cannot be implemented, resulting in cognitive and emotional strain linked to outcomes like burnout and staff turnover. Despite extensive cross-cultural validation of the Measure of Moral Distress for Healthcare Professionals (MMD-HP), no Italian adaptation currently exists, limiting research in Italian contexts.

Aim

To culturally adapt and validate the Italian version of the Measure of Moral Distress for Healthcare Professionals (MMD-HP-ITA) within two major Italian healthcare settings.

Methods

An observational multicenter cross-sectional study was conducted from December 2022 to September 2023. The original questionnaire underwent forward-backward translation. Confirmatory and exploratory factor analyses evaluated structural validity, and Cronbach’s alpha assessed internal consistency. Construct validity was tested by correlating scores with the Ethical Leadership Scale.

Participants

A sample of 567 healthcare professionals (median age 43 years; 74% female; 74% nurses) was recruited and completed the Italian version of the questionnaire online.

Ethical consideration

The study was approved by the Ethics Committees of the two healthcare institutions involved. Informed consent was obtained from all participants.

Results

The Italian version demonstrated strong internal consistency (Cronbach’s α = 0.96). Exploratory factor analysis supported a three-factor model explaining 58.6% of the variance, with dimensions reflecting: (1) System-level constraints, (2) Team-level dynamics, and (3) Patient/family-level conflicts. Convergent validity was confirmed via significant associations with related constructs: moral distress scores were higher among nurses, younger professionals, and those considering job departure, and negatively correlated with ethical leadership ratings (r = −0.375, p < 0.001).

Conclusion

The Italian version of the Measure of Moral Distress for Healthcare Professionals is a reliable and valid instrument for assessing moral distress among Italian healthcare professionals, effectively capturing the multidimensionality of the construct in a culturally relevant way.

Keywords

moral distress health personnel cross-cultural comparison psychometrics surveys and questionnaires burnout

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