Assessing moral injury in health care workers living in secular societies: introducing the Health care‐Moral Injury Scale (HMIS)

Purpose

The adverse impact of moral injury on health care workers is well documented, for example during the COVID-19 pandemic. However, currently available measures are unsuitable for assessing moral injury in health care workers living in secular societies such as the United Kingdom. The current study introduces and validates the Health care-Moral Injury Scale (HMIS).

Method

The 10-item HMIS was designed during the COVID-19 pandemic to assess moral injury in health care workers. Between September and October 2020, 858 health care workers completed the scale and other measures. A factor structure was identified by exploratory and confirmatory factor analysis and correlations were used to test the convergent (burnout, hope, mistrust) and divergent (loneliness) validity of the HMIS. Regression analyses tested the criterion-related validity of the HMIS against measures of depression, anxiety and PTSD.

Results and Conclusions

The HMIS was found to be a unidimensional scale comprised of three conceptual components. There was evidence of good convergent validity, with a medium-sized correlation between the total moral injury score and burnout. However, correlations were weaker for loss of hope and loss of trust. Moral injury was not significantly associated with loneliness when controlling for mental health difficulties, indicating good divergent validity. Moral injury scores predicted worse severity of depression, anxiety and PTSD, supporting criterion-related validity. Findings suggest that the HMIS is a valid scale that can be used by researchers to assess moral injury specifically in a health care context.