# Development and validation of the Healthcare Worker Stress Scale-Vietnamese: a culturally grounded instrument to assess work-related stress

## TL;DR

This paper introduces a new stress assessment tool for healthcare workers in Vietnam, designed to measure work-related stress with cultural relevance and high reliability.

## Contribution

The paper presents a validated, culturally grounded stress scale for Vietnamese healthcare workers, including new domains specific to local stressors.

## Key findings

- The Healthcare Worker Stress Scale-Vietnamese (HWSS-V) has 44 items with strong reliability (Cronbach’s alpha = 0.96) and five validated domains.
- The scale can be used for hospital-level stress monitoring and crisis response, enabling targeted interventions for high-risk groups.
- The tool includes new domains like work-family conflict and occupational hazards, which are relevant in Vietnamese healthcare settings.

## Abstract

Reliable measurement of occupational stress is essential for designing effective interventions for healthcare workers; however, Vietnam currently lacks culturally validated assessment tools.

To develop and validate the Healthcare Worker Stress Scale – Vietnam (HWSS-V), a profession-inclusive, culturally grounded instrument that extends the Health Professions Stress Inventory (HPSI) and the Nursing Stress Scale (NSS) by adding Vietnam-salient domains and crisis-monitoring utility.

We conducted a cross-sectional survey of 520 physicians, nurses, and medical technicians at two university hospitals (June–December 2021). Fifty items adapted from HPSI/NSS underwent forward – backward translation and expert review. Psychometric evaluation included item-level content validity index (I-CVI), scale-level content validity index (S-CVI), exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and reliability testing (Cronbach’s alpha).

All fifty items showed strong content validity (I-CVI ≥0.80; κ 0.67–0.97; S-CVI = 0.90). EFA supported a five-factor structure. After removing six low-loading items, forty-four items explained 87.1% of variance with excellent reliability (overall Cronbach’s alpha = 0.96; subscales 0.85–0.95). CFA indicated acceptable fit (Root Mean Square Error of Approximation = 0.077; Standardized Root Mean Squared Residual = 0.060; Tucker – Lewis Index = 0.827; Comparative Fit Index = 0.816).

HWSS-V enables practical hospital-level stress surveillance and quality improvement. Hospitals can: (i) embed HWSS-V into biannual staff health checks to benchmark units and triage high-risk groups; (ii) integrate scores into dashboards to trigger tailored responses; and (iii) deploy rapid assessments during crises (e.g. outbreaks, patient surges) to guide resource allocation. By addressing culturally specific stressors across major clinical professions, HWSS-V provides actionable capabilities beyond HPSI/NSS for Vietnam’s hospitals.

● Main findings: We developed and validated a forty-four-item Healthcare Worker Stress Scale-Vietnamese version with five domains and strong reliability, confirming a coherent factor structure in a sample of five hundred and twenty healthcare workers.● Added knowledge: The scale provides a culturally specific and profession-inclusive measure of healthcare worker stress, adding domains on work – family conflict and occupational hazards that are highly relevant in contemporary Vietnamese healthcare.● Global health impact for policy and action: The scale enables routine surveillance of staff stress and targeted organizational interventions, supporting workforce well-being and patient safety in resource-limited health systems.