Reliability and Validity Test of the Indonesian Version of the Hamilton Anxiety Rating Scale (HAM-A) to Measure Work-related Stress in Nursing
Introduction: Specific work characteristics have placed nurses as one of the professions with a high level of work-related stress. If not managed properly, work-related stress can cause adverse effects. Signs of stress can be seen in people's behavior, thinking or physical symptoms. One of a subjective measurement tool that is widely used to measure work-related stress is the Hamilton Anxiety Rating Scale (HAM-A), however, the literature that discusses the results of the HAM-A translation, validity and reliability test in the nurse profession is still limited. This study aims to translate HAM-A into the Indonesian version, then test its validity and reliability in nurses.
Methods: A Cross-sectional study with stratified random sampling method was conducted on 98 nurses from July to August 2018. The English version of HAM-A consists of 14 items has been a translation into Indonesian version. Pearson Product Moment Correlation was used to evaluate the construct validity and Cronbach's alpha scores were used to assess the internal consistency reliability of the Indonesian version of HAM-A.
Results: Item construct validity based on the Pearson correlation ranged from 0.529 to 0.727, Cronbach’s alpha reliability was obtained at 0.756.Conclusion:The Indonesian version of the HAM-A fulfills the criteria of a reliable (fair acceptable criteria) and valid (good criteria) assessment tool to assess the work-related stress in the nursing profession.
Aqel, N. A., & Thabet, A. (2017). Work and Family Stressors , Depression , and Anxiety among Working Women in Gaza Strip. Global Journal of Intellectual & Develompental Disabilities (GJIDD), 555615(November), 001–006.
Beaton, D. E., Bombardier, C., Guillemin, F., Ferraz, M. B., Borsa, J. C., Wamser, G. H., … Schoemaker, M. M. (2000). Guidelines for the Process of Cross-Cultural Adaptation of Self-Report Measures. Spine, 25(24), 3186–3191. https://doi.org/10.1111/cch.12124
Bolarinwa, O. A. (2015). Principles and methods of validity and reliability testing of questionnaires used in social and health science researches. Nigerian Postgraduate Medical Journal, 22(4), 195–201. doi: 10.4103/1117-1936.173959
Bryman, A. (2001). Social Research Methods. New York: Oxford University Press Inc.
Cicchetti, D. V. (1994). Guidelines, Criteria, and Rules of Thumb for Evaluating Normed and Standardized Assessment Instruments in Psychology. Psychological Assessment, 6(4), 284–290. https://doi.org/10.1037/1040-3518.104.22.1684
Clark, D. B., & Donovan, J. E. (1994). Reliability and Validity of the Hamilton Anxiety Rating Scale in an Adolescent Sample. Journal of the American Academy of Child & Adolescent Psychiatry, 33(3), 354–360. doi: 10.1097/00004583-199403000-00009
Craiovan, P. M. (2015). Burnout, Depression and Quality of Life among the Romanian Employees Working in Non-governmental Organizations. Procedia - Social and Behavioral Sciences, 187, 234–238. https://doi.org/10.1016/j.sbspro.2015.03.044
Deguchi, Y., Iwasaki, S., Ishimoto, H., Ogawa, K., Fukuda, Y., Nitta, T., … Inoue, K. (2017). Relationships between temperaments, occupational stress, and insomnia among Japanese workers. PLoS ONE, 12(4), 1–13. https://doi.org/10.1371/journal.pone.0175346
Eisinga, R., Grotenhuis, M. Te, & Pelzer, B. (2013). The reliability of a two-item scale: Pearson, Cronbach, or Spearman-Brown? International Journal of Public Health, 58(4), 637–642. https://doi.org/10.1007/s00038-012-0416-3
Fan, L. B., Blumenthal, J. A., Watkins, L. L., & Sherwood, A. (2015). Work and home stress: Associations with anxiety and depression symptoms. Occupational Medicine, 65(2), 110–116. https://doi.org/10.1093/occmed/kqu181
Gencoz, F., Gencoz, T., & Soykan, A. (2007). Psychometric properties of the Hamilton Depression Rating Scale and other physician-rated psychiatric scales for the assessment of depression in ESRD patients undergoing hemodialysis in Turkey. Journal Psychology, Health & Medicine, 12(4), 450–459. doi: 10.1080/13548500600892054
Gupta, R., Punia, A., Mathur, S., Gupta, R., Kawatra, A., & Verma, K. (2014). Assessment of psychological stress in first year students of a private Indian Journal of Basic and Applied Medical Research. Indian Journal of BAsic and Applied MEdical Research, 1956(March), 437–443.
Hamilton, M. (1959). The assessment of anxiety states by rating. The British Journal of Medical Psychology, 32(1), 50–55. DOI: 10.1111/j.2044-8341.1959.tb00467.x
Hashmi, A. M., Naz, S., Asif, A., & Khawaja, I. S. (2016). Urdu translation of the hamilton rating scale for depression: Results of a validation study. Pakistan Journal of Medical Sciences, 32(6), 1479–1483. https://doi.org/10.12669/pjms.326.11399
Huerta-Franco, M.-R. (2013). Effects of occupational stress on the gastrointestinal tract. World Journal of Gastrointestinal Pathophysiology, 4(4), 108. https://doi.org/10.4291/wjgp.v4.i4.108
International Labour Organization. (2016). Workplace Stress. World Day for Safety and Health at Work. Turin - Italy: International Labour Organization. https://doi.org/10.1017/CBO9781107415324.004
Karanikola, M. N. K., Giannakopoulou, M., Kalafati, M., Kaite, C. P.,
Patiraki, E., Mpouzika, M., … Middleton, N. (2016). Anxiety symptoms and quality of interaction among oncology nurses: A correlational, cross-sectional study. Revista Da Escola de Enfermagem, 50(5), 800–807. https://doi.org/10.1590/S0080-623420160000600013
Katherine Shear, M., Bilt, J. Vander, Rucci, P., Endicott, J., Lydiard, B., Otto, M. W., … Frank, D. M. (2001). Reliability and validity of a Structured Interview Guide for the Hamilton Anxiety Rating Scale (SIGH-A). Depression and Anxiety, 13(4), 166–178. https://doi.org/10.1002/da.1033
Khamisa, N., Peltzer, K., Ilic, D., & Oldenburg, B. (2017). Effect of personal and work stress on burnout, job satisfaction and general health of hospital nurses in South Africa. Health SA Gesondheid, 22, 252–258. https://doi.org/10.1016/j.hsag.2016.10.001
Kline, P. (2000). The Handbook of Psychological Testing (Second). London and New York: Routledge.
La Torre, G., Sestili, C., Mannocci, A., Sinopoli, A., De Paolis, M., De
Francesco, S., … De Giusti, M. (2018). Association between Work Related Stress and Health Related Quality of Life: The Impact of Socio-Demographic Variables. A Cross Sectional Study in a Region of Central Italy. International Journal of Environmental Research and Public Health, 15(1), 159. https://doi.org/10.3390/ijerph15010159
Li, J., Loerbroks, A., Bosma, H., & Angerer, P. (2016). Work stress and cardiovascular disease: A life course perspective. Journal of Occupational Health, 58(2), 216–219. https://doi.org/10.1539/joh.15-0326-OP
López-Pina, J. A., Sánhez-Meca, J., & Rosa-Alcázar, A. I. (2009). The Hamilton Rating Scale for Depression: a meta analytic reliability generalization study. International Journal of Clinical and Health Psychology, 9(9), 143–159.
Maier, W., Buller, R., Philip, M., & Heuser, I. (1988). The Hamilton Anxiety Rating Scale: Reliability, validity and sensitivity to change in anxiety and depresive disorders. J Affect Disord, 14(1), 61–68. DOI:10.1016/0165-0327(88)90072-9
McDermott, R. (2011). Internal and external validity. In J. N. Druckman, D. P. Green, J. H. Kuklinski, & A. Lupia (Eds.), Cambridge handbook of experimental political science. Cambridge: Cambridge University Press. https://doi.org/10.1017/CBO9780511921452.003
Michalopoulos, L. T. M., Murray, L. K., Kane, J. C., Van Wyk, S. S.,
Chomba, E., Cohen, J., … Bolton, P. A. (2015). Testing the validity and reliability of the Shame Questionnaire among sexually abused girls in Zambia. PLoS ONE, 10(4), 1–17. https://doi.org/10.1371/journal.pone.0123820
Michie, S. (2002). Causes and management of stress at work. Occupational Environ Med, 59, 67–72. https://doi.org/10.1136/oem.59.1.67
Moore, S., Sikora, P., Grunberg, L., & Greenberg, E. (2007). Work Stress and Alcohol Use: Examining the Tension-Reduction Model as a Function of Worker’s Parent’s Alcohol Use. Addict Behav, 32(12), 3114–3121. https://doi.org/10.1016/j.immuni.2010.12.017.Two-stage
Moustaka, E., & Constantinidis, T. C. (2010). Sources and effects of work-related stress in nursing. Health Science Journal, 4(4), 210–216.
Nafeesa, M., Vidhya, V., Vijayalakshmi, P., & Rajkumar, P. (2017). Annals of Musculoskeletal Disorders Central Perceived Work-Related Psychosocial Stress and Musculoskeletal Disorder Complaints among Call Centre Workers in India – A Cross Sectional Study. Ann Musc Disord, 1(1), 1–6. Retrieved from https://www.jscimedcentral.com/MusculoskeletalDisorders/musculoskeletaldisorders-1-1005.pdf
Nunnally, J. C., & Bernstein, I. H. (1994). Psychometric Theory (3rd ed.). USA: McGraw-Hill, Inc. https://doi.org/10.1177/014662169501900308
Obradović, J., & Čudina-Obradović, M. (2013). Work Stress and Marital Quality in Dual Earner Couples: A Test of Three Mediation Models. Drustvena Istrazivanja, 22(4), 673–691. https://doi.org/10.5559/di.22.4.06
Piko, B. F. (2006). Burnout, role conflict, job satisfaction and psychosocial health among Hungarian health care staff: A questionnaire survey. International Journal of Nursing Studies, 43(3), 311–318. https://doi.org/10.1016/j.ijnurstu.2005.05.003
Pillay, R. (2009). Work satisfaction of professional nurses in South Africa: A comparative analysis of the public and private sectors. Human Resources for Health, 7(15), 1–10. https://doi.org/10.1186/1478-4491-7-15
Portney, L., & Watkins, M. (2009). Foundations of clinical research: applications to practice Pearson education. New Jersey: Upper Saddle River.
Prasad, K. M., Udupa, K., Kishore, K., Thirthalli, J., Sathyaprabha, T., & Gangadhar, N. (2009). Inter-rater reliability of Hamilton depression rating scale using video-recorded interviews — Focus on rater-blinding. Indian Journal of Psychiatry, 51(3), 191–194. doi: 10.4103/0019-5545.55085
Rose, D. M., Seidler, A., Nübling, M., Latza, U., Brähler, E., Klein, E. M., … Beutel, M. E. (2017). Associations of fatigue to work-related stress, mental and physical health in an employed community sample. BMC Psychiatry, 17(1), 1–8. https://doi.org/10.1186/s12888-017-1237-y
Singh, A. S., & Masuku, M. B. (2014). Sampling Techniques & Determination of Sample Size in Applied Statistics Research: An Overview. International Journal of Economics, Commerce and Management, 2(11), 1–22. doi: 10.12691/jpar-3-1-8.
Stathopoulou, H., Karanikola, M., Panagiotopoulou, F., &
Papathanassoglou, E. (2011). Anxiety levels and related symptoms in emergency nursing personnel in Greece. J Emerg Nurs, 37(4), 314–320. doi: 10.1016/j.jen.2010.03.006
Taber, K. S. (2018). The Use of Cronbach’s Alpha When Developing and Reporting Research Instruments in Science Education. Research in Science Education, 48(6), 1273–1296. https://doi.org/10.1007/s11165-016-9602-2
Taherdoost, H. (2016). Validity and Reliability of the Research Instrument ; How to Test the Validation of a Questionnaire / Survey in a Research. International Journal of Academic Research InManagement (IJARM), 5(3), 28–36. http://dx.doi.org/10.2139/ssrn.3205040
Terwee, C. B., Bot, S. D. M., de Boer, M. R., van der Windt, D. A. W. M., Knol, D. L., Dekker, J., … de Vet, H. C. W. (2007). Quality criteria were proposed for measurement properties of health status questionnaires. Journal of Clinical Epidemiology, 60(1), 34–42. https://doi.org/10.1016/j.jclinepi.2006.03.012
Thompson, E. (2015). Hamilton rating scale for anxiety (HAM-A). Occupational Medicine, 65(7), 601. https://doi.org/10.1093/occmed/kqv054
Ursachi, G., Horodnic, I. A., & Zait, A. (2015). How Reliable are Measurement Scales? External Factors with Indirect Influence on Reliability Estimators. Procedia Economics and Finance, 20(15), 679–686. https://doi.org/10.1016/s2212-5671(15)00123-9
Vernekar, S. P., & Shah, H. (2018). A study of work-related stress among nurses in a tertiary care hospital in Goa. International Journal of Cummunity Medicine and Public Health, 5(2), 657–661. doi: http://dx.doi.org/10.18203/2394-6040.ijcmph20180246
Vignoli, M., Muschalla, B., & Mariani, M. G. (2017). Workplace Phobic Anxiety as a Mental Health Phenomenon in the Job Demands-Resources Model. BioMed Research International, 1–10. https://doi.org/10.1155/2017/3285092
World Health Organization (WHO). (2007). Stress at the workplace. Geneva.
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