Psychometric evaluation of the emergency department stressors scale and the Utrecht work engagement scale: From the Danish DE-STRESS survey

BACKGROUND: Emergency Department (ED) clinicians experience high occupational stress, which may negatively affect well-being and retention. The DE-STRESS survey was developed in Australia to assess ED stressors, coping, and turnover intentions. The ten independent scales in the Danish version (DE-STRESS DK) have been culturally adapted but not yet psychometrically evaluated. AIM: To evaluate construct validity and reliability of two DE-STRESS DK subscales: the Emergency Department Stressors Scale (EDSS) and the Utrecht Work Engagement Scale (UWES-9), among ED clinicians in Denmark. METHODS: A cross-sectional methodological study was conducted in three Danish EDs. Construct validity was assessed through hypothesis testing. Test-retest reliability was evaluated using weighted Cohen's kappa and intraclass correlation coefficients (ICC). For UWES-9, internal consistency was assessed using Cronbach's alpha and measurement error using a Bland-Altman plot. RESULTS: The EDSS showed limited construct validity (1/12 hypotheses supported) and moderate test-retest reliability (κ = 0.30-0.45). UWES-9 demonstrated acceptable construct validity (3/6 hypotheses supported), excellent internal consistency (α = 0.94), good test-retest reliability (ICC = 0.75), with minimal systematic bias. CONCLUSION: The EDSS requires further cultural adaptation before use in Danish EDs. UWES-9 appears valid and reliable for assessing work engagement in research and clinical practice.