Modelling the multidimensional structure of workplace violence against emergency medical technicians and mitigation strategies in Ghana: a confirmatory factor analysis

Emergency Medical Technicians (EMTs) are routinely exposed to workplace violence, yet empirical evidence from low- and middle-income countries remains limited. This study examined the multidimensional structure of workplace violence against EMTs in Ghana, evaluated perceived mitigation strategies using a confirmatory factor analysis (CFA) approach and explored EMTs’ perceptions of workplace violence mitigation strategies. A cross-sectional survey was conducted among 336 EMTs across three regions of Ghana. Workplace violence was measured using 23 items, and mitigation strategies using 10 items. A two-step approach was employed: an exploratory factor analysis (EFA) to ascertain the underlying factor structure, followed by CFA to validate the identified structure from the EFA. We used a weighted least-squares mean-and-variance-adjusted estimator appropriate for ordinal data. Model reliability, convergent validity, and inter-construct relationships were assessed. The CFA supported a three-factor structure comprising verbal/non-physical abuse, physical assault, and severe violent attacks, with strong internal consistency (α = 0.812–0.939) and high convergent validity (AVE > 0.75). The study revealed strong structural covariance between physical assault and severe violent attacks (r = 0.668), moderate covariance between physical assault and verbal abuse (r = 0.439), and weaker but significant covariance between severe attacks and verbal abuse (r = 0.347). Most respondents (84%) expressed high concern about workplace violence. Aggression management, defensive tactical training, and resilience training were perceived as the most effective mitigation strategies. Workplace violence against EMTs in Ghana is multidimensional and highly interrelated. Interventions should prioritize early de-escalation, organizational protection mechanisms, and national EMS violence-prevention policies. Addressing verbal and physical abuse concurrently may prevent escalation into severe violence.