Table of Contents
Abstract
The Health Care Workers' Concerns in infectious outbreaks Scale (HCWCIOS) is a specialized psychometric instrument engineered to quantify the multifaceted anxieties experienced by medical personnel during pandemic events. Developed in response to the profound occupational and psychological toll of the COVID-19 crisis, this tool moves beyond generic stress measures to capture the unique, context-specific worries of frontline staff. By systematically evaluating these concerns, the scale provides a critical metric for healthcare administrators seeking to safeguard their workforce and maintain operational continuity during global health emergencies.
Constructed through a rigorous exploratory sequential mixed-methods design, the HCWCIOS bridges qualitative insights from active healthcare workers with robust quantitative validation. The instrument captures a comprehensive spectrum of occupational distress, ranging from tangible deficits in training to the psychological burden of social stigmatization. For researchers and occupational health professionals, this scale represents a vital advancement in pandemic preparedness, offering a validated framework to identify vulnerable staff cohorts and implement targeted psychological interventions before burnout or absenteeism compromises patient care.
📊 Psychometric Scorecard
36
Multidimensional
0.91
📍 Iran
Authors
Purpose
Historically, research into the psychological impact of pandemics on medical staff relied heavily on ad-hoc or unvalidated questionnaires, limiting the reliability and cross-comparability of findings. The HCWCIOS was developed to address this critical methodological gap by providing a psychometrically sound, standardized measure specifically tailored to the nuances of infectious disease outbreaks.
For clinicians and healthcare administrators, this instrument is invaluable because it disaggregates generalized pandemic stress into actionable domains. By pinpointing exactly what is driving staff anxiety—whether it is a lack of protective equipment, fear of infecting family members, or overwhelming patient loads—leadership can deploy precise, evidence-based support strategies rather than relying on generic wellness initiatives.
Construct
The psychological construct of pandemic-related occupational concern measured by the HCWCIOS is conceptualized as a multidimensional phenomenon encompassing cognitive, environmental, and social domains. Rather than viewing anxiety as a purely internal affective state, this framework recognizes that healthcare worker distress emerges from the interaction between the individual and their high-risk occupational environment.
The construct is operationalized across six distinct dimensions: perceived deficits in institutional readiness, informational gaps regarding the pathogen, cognitive appraisals of personal danger, the deterioration of interpersonal networks due to stigma, the acute burden of clinical duties, and the behavioral consequence of these stressors. Together, these dimensions form a holistic model of occupational vulnerability during biological crises.
Validity
To ensure the instrument accurately captures the intended construct, the developers employed a comprehensive validation protocol starting with a strong qualitative foundation. Face and content validity were meticulously established through expert review and participant feedback, utilizing quantitative metrics to objectively eliminate weak items. The scale achieved an exceptional average Scale-Level Content Validity Index of 0.93, indicating near-unanimous expert agreement on the relevance of the retained items.
Construct validity was subsequently confirmed through exploratory techniques, demonstrating that the theoretical dimensions of pandemic concern mapped cleanly onto distinct statistical factors. This rigorous alignment between theory and statistical output provides strong empirical support that the HCWCIOS measures exactly what it claims to measure.
Reliability
The psychometric stability of the HCWCIOS is robust, demonstrating excellent internal consistency and temporal reliability. When evaluating how well the items within the scale correlate with one another, the overall instrument yielded a Cronbach's alpha of 0.912, which sits well above the conventional threshold for excellent reliability in psychological testing. The individual subscales also performed admirably, with alpha values ranging from 0.735 to 0.864, indicating that each specific domain reliably captures its target facet of concern without excessive redundancy.
Furthermore, the instrument's stability over time was confirmed via test-retest methodology, producing an intra-class correlation coefficient of 0.880. This high degree of temporal stability is particularly crucial for longitudinal research, ensuring that any measured changes in staff concerns over the course of a pandemic reflect true psychological shifts rather than measurement error.
Factor Analysis
The underlying architecture of the HCWCIOS was delineated using Exploratory Factor Analysis, a statistical technique used to uncover the latent variables driving participants' responses. The dataset proved highly suitable for this approach, as evidenced by a Kaiser-Meyer-Olkin measure of 0.872 and a highly significant Bartlett's test.
Through principal component extraction and Varimax rotation, the analysis distilled the initial item pool into a clean, six-factor structure that collectively accounts for 46.507% of the total variance in healthcare workers' concerns. During this rigorous process, items that failed to load strongly onto a single factor were systematically eliminated, refining the tool from 57 preliminary questions down to a highly optimized 36-item final scale.
Subscales
| Subscale | Items | Description |
|---|---|---|
| Inadequate Preparedness | 8 items | Evaluates concerns regarding the lack of institutional readiness, skills, and equipment to handle the pandemic. |
| Lack of Knowledge | 7 items | Assesses worries stemming from insufficient information, specialized expertise, and understanding of the novel pathogen. |
| Risk Perception | 6 items | Measures the cognitive appraisal of personal danger and the perceived threat of contracting or transmitting the disease. |
| Affected Social Relations | 6 items | Captures the psychological impact of social stigmatization, isolation, and strained interpersonal dynamics due to working in high-risk environments. |
| Work Pressure | 6 items | Quantifies distress related to increased clinical workloads, occupational stress, and the acute demands of patient care during an outbreak. |
| Absenteeism | 3 items | Evaluates the behavioral consequences of pandemic-related stress, specifically the urge or necessity to miss work. |
Instrument
| Test Type | Self-report questionnaire |
| Format | 36 items |
| Language | Persian |
| Population | Healthcare professionals, Nurses |
| Age Group | Adults |
| Administration | Electronic questionnaire |
Figures
Health Care Workers' Concerns in Infectious Outbreaks Scale Items
Items are currently not available
The individual items of this scale are not publicly available. Researchers interested in using this instrument should contact the original authors directly to request the scale materials.
Sample
304 Iranian healthcare workers (mean age = 32.25 years, SD = 7.34). The sample was predominantly female (67.10%), married (60.20%), and held bachelor's degrees (70.40%). Nurses comprised 55.30% of the sample, and 88.10% had direct contact with patients. Participants were recruited via convenient sampling.
Cite This Paper
Sajad Yarahmadi, Mojgan Khademi, Farzad Ebrahimzadeh, Tayebeh Cheraghian, Elham Shahidi Delshad (2022). Health Care Workers' Concerns in infectious outbreaks Scale. Frontiers in psychology. https://doi.org/10.3389/fpsyg.2022.1108835
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Cite this article
Mohammed looti (2026). Health Care Workers’ Concerns in Infectious Outbreaks Scale. PSYCHOLOGICAL SCALES. Retrieved from https://scales.arabpsychology.com/s/health-care-workers-concerns-in-infectious-outbreaks-scale/
Mohammed looti. "Health Care Workers’ Concerns in Infectious Outbreaks Scale." PSYCHOLOGICAL SCALES, 14 Aug. 2026, https://scales.arabpsychology.com/s/health-care-workers-concerns-in-infectious-outbreaks-scale/.
Mohammed looti. "Health Care Workers’ Concerns in Infectious Outbreaks Scale." PSYCHOLOGICAL SCALES, 2026. https://scales.arabpsychology.com/s/health-care-workers-concerns-in-infectious-outbreaks-scale/.
Mohammed looti (2026) 'Health Care Workers’ Concerns in Infectious Outbreaks Scale', PSYCHOLOGICAL SCALES. Available at: https://scales.arabpsychology.com/s/health-care-workers-concerns-in-infectious-outbreaks-scale/.
[1] Mohammed looti, "Health Care Workers’ Concerns in Infectious Outbreaks Scale," PSYCHOLOGICAL SCALES, vol. X, no. Y, ص Z-Z, August, 2026.
Mohammed looti. Health Care Workers’ Concerns in Infectious Outbreaks Scale. PSYCHOLOGICAL SCALES. 2026;vol(issue):pages.