The Swedish moral injury symptoms scale–health professional: psychometric evaluation in a sample of hospital-based healthcare professionals across Sweden

Background The COVID-19 pandemic has increased attention to moral injury (MI) among healthcare professionals (HCPs). MI refers to the psychological distress that may arise following exposure to events that violate individuals’ deeply held moral beliefs. The Moral Injury Symptoms Scale–Health Professional (MISS-HP) is an instrument designed to assess MI symptoms among HCPs. Although the MISS-HP has been evaluated in several countries, divergent psychometric solutions have been reported, and the instrument has not yet been evaluated in Sweden. Objective To evaluate the psychometric properties of the Swedish version of the MISS-HP among hospital-based HCPs. Methods HCPs were recruited using an online survey distributed across Swedish hospitals. Exploratory factor analysis (EFA) was performed to investigate the factorial structure of the MISS-HP. Internal consistency was assessed using McDonald’s Omega and construct validity through measures of psychological distress. Recevier operating characteristic (ROC) analysis was used to estimate a candidate cut-off score. Results The sample included 585 HCPs (mean age = 45.95 years, 72.2% women, 51.4% nurses). EFA supported a two-factor solution (Guilt/Shame, Trust/Meaning) comprising six of the original MISS-HP ten items and showed good fit [ χ 2 (4) = 9.07, p = 0.059; RMSEA = 0.046; TLI = 0.975; RMSR = 0.018], accounting for 43.6% of the total variance. McDonald’s Omega indicated good internal consistency ( ω = 0.80). Measures of psychological distress were moderately associated with MISS-HP scores and ROC analysis identified a candidate cut-off score of ≥ 20. Conclusion The resulting six-item Swedish MISS-HP demonstrated satisfactory psychometric performance for measuring MI symptoms in the sample.