Development and psychometric evaluation of a new instrument for firefighter’s occupational resilience assessment: An exploratory mixed-methods study

doi:10.21203/rs.3.rs-4007724/v1

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Development and psychometric evaluation of a new instrument for firefighter’s occupational resilience assessment: An exploratory mixed-methods study

https://doi.org/10.21203/rs.3.rs-4007724/v1

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Introduction: Increasing firefighters’ occupational resilience promotes their safety and safe performance in hazards. Despite its significance, no instrument has so far been developed to assess firefighters’ occupational resilience. The present study, therefore, aimed to design such an instrument.

Material and methods: Firefighter’s occupational resilience indicators were first extracted through a systematic review and a qualitative study to develop the preliminary items. The face and content validity of the items were then examined. The remaining items underwent an exploratory factor analysis (EFA), test-retest reliability, and finally a confirmatory factor analysis (CFA).

Results: After content validity, 49 out of the 94 preliminary items were assessed in terms of construct validity. EFA and rotation revealed that five factors explained 42.477% of the total variance of the questionnaire. The 42 items were categorized into five domains of self-efficacy (20 items), legality (7 items), organizational trust (6 items), self-regulation (5 items), and job satisfaction (4 items). The instrument was finalized with a CFA of the final model and test-retest reliability assessment.

Conclusion: All the personal, organizational, and environmental aspects related to firefighters must be considered for resilience evaluation. This instrument can facilitate firefighters’ resilience assessment. With the outcome of this instrument, firefighters and fire department managers can identify weaknesses, strengths, and assess the effectiveness of interventions to improve firefighters’ occupational resilience.

Firefighters

Resilience

Safety

Competency

Occupational

Firefighting is globally regarded as a hazardous job[1]. As physical abilities are essential for this profession, the US National Fire Protection Association proposes standards for periodic evaluation of firefighters’ abilities to ensure their compatibility with their job [2, 3]. Firefighters must often carry out their occupational tasks, e.g., saving lives and extinguishing fire, with maximum physical strength. They constantly witness tragic and sad events such as death, bodies being carried, or severed body parts. Therefore, they must have a high psychological capacity in addition to physical preparedness and adaptation [4]. Resilience is defined as personal coping with stressful events, e.g., harms, threats, tragedies, diseases, and interpersonal, familial, financial, occupational, and health-related problems, and can mitigate the negative impacts of these events [5].

Resilience encompasses flexibility, improvement, and recovery after facing unpleasant situations [6]. According to researchers, resilience is not merely durability in the face of threatening conditions or harms; rather, resilient people actively and constructively participate in the environment and can establish a bio-psychological balance in hazardous situations [7]. Most definitions of this concept revolve around two basic concepts of hardship and positive coping [8], although these definitions overlap to some extent. The definition of resilience varies from a personality trait to a dynamic process [9]. This concept is gaining more momentum in the management literature to provide adaptation to hardship and tolerance of occupational pressure to concerning occupational impacts [10]. Incompetency and lack of experience among firefighters has led to serious occupational injuries [11]. Few other professions require such a high level of physical and psychological strength[12] and, as such, firefighters’ resilience merits more attention. Resilience is the ability to overcome crises by using personal and socially-mediated resources as an opportunity for development [12, 13]. It is a multi-dimensional, dynamic, and compensatory process strongly dependent on personal abilities. For firefighters who deal with potentially harmful situations every day, resilience is defined as mental ability, the ability to carry out occupational tasks, and the quality of life [12]. An analysis of relief workers disaster resilience demonstrated that resilience is a function of personality indicators, perceived control, self-efficacy, coping mechanisms, and social support [14]. Another study examined the factors contributing to the successful reduction in firefighter’s mortality in the US. Based on the results, the keys to success included interventions focusing on firefighters’ health status, hazard perception, cardiac health program, physical and mental health promotion, post-disaster rehabilitation, managerial factors’ improvement, fire engine safety enhancement, lessons learned, education, technology development, and NFPA code development [15]. There is no instrument to measure firefighters’ professional occupational resilience, which mandates the design of such an instrument.

The current study aimed to develop a standard and valid tool for evaluating firefighters’ resilience in terms of physical, psychological, personality, behavioral, and demographic characteristics, as well as occupational skills such that firefighters’ resilience can be rapidly and easily measured with this instrument. The results of this assessment can help fire department staff and managers identify weaknesses, strengths, and then provide interventions to enhance firefighters’ resilience and safety.

This instrument can be administered along with other instruments to identify resilient firefighters for working in difficult conditions during disasters. The recruitment of such competent individuals for this profession can promote the safety and security of society.

This exploratory-sequential mixed-methods study was conducted in two phases. In the first phase, an item pool was generated based on a systematic review and a qualitative study to develop the preliminary questionnaire. In the second phase, the questionnaire underwent psychometric evaluation in a quantitative study. Figure 1 schematically depicts the process of this research.

Phase 1: Item generation and questionnaire design

Item generation

A systematic review was conducted to extract international indicators affecting firefighters’ resilience. Based on inclusion and exclusion criteria, relevant studies were identified, and the factors and indicators affecting firefighters’ resilience were extracted [16].

To extract components based on stakeholders’ experiences, a qualitative study was conducted using conventional content analysis. Overall, 21 face-to-face interviews were conducted with firefighters with at least five years of work experience [17].

Questionnaire development

An item pool with 688 items was formed by integrating the factors identified in the systematic review and the codes extracted in the qualitative study. After removing similar conceptual and objective items, subjective items underwent psychometric analysis, and the first draft of the items was written.

Psychometric evaluation

The instrument’s face, content, and construct validities were examined at this stage. This phase started in April 2022 and finished in December 2022.

Face validity

Both quantitative and qualitative face validities were measured.

Qualitative face validity

Ten firefighters were asked to give their opinion on the intelligibility of the questions, and the items were modified accordingly.

Quantitative face validity

The same ten firefighters were asked to comment on the importance of questions for examining resilience on a five-point Likert scale. Based on their comments, decisions about the retention of each item were made by using the (importance * frequency) formula as follows:

Impact Score = Frequency (%) × Importance

By calculating the standard impact score for this study, it was decided that indicators with an impact score of less than 1.5 should be discarded.

Phase 2: Content validity

Qualitative content analysis determination

Content validity was assessed both quantitatively and qualitatively. To determine qualitative content validity, 15 experts and researchers with a research background and experience in firefighting, safety, and resilience were asked to evaluate the instrument based on correct grammar, word choice, item placement, and scoring.

Quantitative content analysis determination

The Content Validity Ratio (CVR) as suggested by Lawshe [18], and content validity index (CVI) according to Bausell and Waltz [19]were used as follows:

Content Validity Ratio

The questionnaire was evaluated by 15 firefighters and researchers with a research background and experience in firefighting, safety, health, and emergencies in terms of the necessity of each item on a three-point scale: necessary, useful but not necessary, or not necessary. As 15 experts had participated in this stage, the minimum acceptable value for CVR based on Lawshe’s table was set to 0.49.

$$CVR=\frac{nE-n/2}{N/2}$$

Content Validity Index

Based on the relevancy/specificity indicator, each item was separately examined on a four-point Likert scale by 15 experts and researchers. The criterion was calculated by using the following formula: the number of experts agreeing (scoring item 3 or 4) divided by the total number of experts. The acceptable CVI for each item (I-CVI) was set up to 0.78. All items with a CVI less than this value were removed.

Construct validity examination

Exploratory factor analysis (EFA)

An Explanatory Factor Analysis (EFA) with the maximum likelihood method and Promax Rotation were performed to determine construct validity. The EFA was performed based on Williams et al.'s (2010) five-step guide. A sample-to-variable ratio (N:P ratio) of five was calculated in this study, and some Iran’s provinces such as Tehran, Yazd, and Kurdistan were sampled.

Before factor analysis, the Kaiser-Meyer-Olkin (KMO) sampling test was run to ensure sample adequacy. This index varies from 0 to 1, with higher values indicating a better factor analysis. The minimum acceptable value for this index is 0.5 [20], and higher values demonstrate sampling adequacy [21]. Bartlett’s test of sphericity (BT) was also run to examine data factorability. This test determines whether there is a sufficient correlation among the questionnaire statements so that they can be merged and whether the correlation matrix significantly differs from 0 (p < 0.05) to justify factor analysis [20]. An EFA (factor extraction and rotation) was then conducted. As the Maximum Likelihood )ML( method is the best method for factor extraction [22], EFA with the ML method was adopted in the current study.

The simultaneous use of multiple decision rules was also performed based on Thompson and Daniel's recommendation [23]. Thus, the KMO test, the scree test, and the cumulative variance percentage explained by the extracted factors were adopted. The judgment was based on having an eigenvalue of more than 1, the factors being placed outside the horizontal line of Eigenvalues, and the extracted factors explaining at least 50% of the variance in the intended concept [20, 21].

Varimax and Promax rotations were performed, and the ensuing factors and models were compared. Promax rotation led to the best and most coordinated factors with the qualitative part and provided better interpretation ability.

Instrument reliability

The test-retest method was used to measure the reliability of the instrument. Accordingly, the instrument was administered to 50 participants over a two-week interval. The scores of the two administrations were compared via the intraclass correlation coefficient (ICC). The ICC varies from 0 to 1, and the closer it is to 1, the higher the reliability.

Confirmatory factor analysis (CFA)

CFA provides more precise tests of the factor structure of an instrument. CFA aimed to confirm the model obtained from EFA[24]. According to other researchers, a sample size of 200 is enough for CFA[25, 26]. As there were 42 items, a sample of 200 was used for CFA. 200 firefighters participated in the CFA survey from Yazd, Tehran, and Kurdistan provinces. Three categories of indices including Absolute Fit (RMSEA, SRMR, GFI, chi-square(, Comparative Fit (CFI, IFI, RFI, NFI, TLI), Parsimonious Fit (PCFI, PNFI, AGFI, AIC) were used to examine the model’s fitness.

Item generation results

The item pool comprised 756 items, of which 186 were extracted from the systematic review and 570 from the qualitative study. These items were checked and edited by the research team. Overlapping items with close conceptual similarity were merged or eliminated, and finally, 94 subjective items remained for developing the instrument. The remaining items were then given to the target groups to examine the face and content validity. Table 1 shows the demographic information of participants in this stud

Table 1

Demographic information of participants in the psychometric evaluation of firefighter’s occupational resilience assessment tool
Study stage	Face Validity	Content Validity Validity	Exploratory Factor Analysis	Reliability Assessment	Confirmatory Factor Analysis
Number of participants	10	15	300	50	200
Age (average)	37	36	34	33	35
Work experience(average)	11	10	9	9	10
Experience in Working in the field (average)	10	9	9	8	8
Experience in educating in the disaster field (average)	4	6	4	5	3
Experience in research in the disaster field (average)	6	5	2	3	3

Validity evaluation results

After investigating qualitative face validity based on the authors’ consensus, constructive comments were applied, and each item’s impact score was calculated. Therefore, no item was removed in the quantitative face validity evaluation.

CVR and CVI

At this stage, CVI was calculated based on the comments of 15 experts. At the end of this stage, 49 out of the 94 items remained, and the rest were discarded.

Construct validity examination

Exploratory factor analysis (EFA)

EFA was performed to investigate the factor structure of the questionnaire. The sampling adequacy index in this factor analysis model was 0.911, and the Chi-Square for Bartlett's Test of Sphericity was 5891.950 that indicating the sample adequacy for performing factor analysis.

The visual inspection of the scree plot shows that five factors can explain the instrument’s factor structure (Fig. 2).

By using Varimax rotation, the items were allocated to nine factors that showed a high mutual loading; therefore, Promax rotation was used instead. Promax rotation with 4, 5, and 6 factors was performed in the next rounds. The best state was achieved with five factors.

Finally, 42 items belonged to five factors labeled by the research team: self-efficacy (20 items), organizational trust (6), legality (7), self-regulation (5), and job satisfaction (4) (Table 2).

Table 2

Results of exploratory factor analyses (EFA) of the Firefighters Resilience Assessment Tool (FRAT)
Category	Items	Factor Loading	α	% Variance
Self-efficacy	1. I can control my stress in disaster scenes.	0.473	0.924	16.884
	3. I have a high tolerance threshold.	0.535
	7. I act in a calculated manner in disaster scenes.	0.485
	8. I am hardworking.	0.427
	10. I am in control of my feelings in disaster scenes.	0.437
	11. I have self-confidence when doing my job.	0.549
	12. I am courageous in disaster scenes.	0.591
	16. I can make correct decisions in sensitive situations.	0.628
	18. I can think correctly when I’m under pressure.	0.622
	19. I can tolerate long-term stress.	0.567
	20. I can sleep in difficult situations.
	24. I can make correct decisions in critical situations with my creativity.	0.591
	27. I am skillful in my job.	0.657
	28. I am skillful in finding the path to unknown locations.	0.677
	29. I have enough skill in using the equipment.	0.595
	30. I have diverse professional skills.	0.665
	31. I can correctly manage the time on missions.	0.519
	32. I am skillful in dividing my energy on disaster scenes.	0.579
	37. I have adequate experience to deal with disasters.	0.648
	39. I can tolerate heart-rending scenes.	0.490
Organizational Trust	48. I am satisfied with the mental and social support within the organization.	0.848	0.889	9.263
	46. I am satisfied with the conditions of my organization.	0.833
	47. The managers of my organization have the optimal experience.	0.766
	49. I think my colleagues perform well on disaster scenes.	0.587
	54. We have appropriate personal protective equipment (PPE).	0.558
	55. People in the region where I work have a positive attitude towards firefighters.	0.480
Legality	5. I always use personal protective equipment (PPE).	0.462	0.771	6.864
	9. I always listen to experienced people.	0.510
	13. I am adequately cautious on missions.	0.568
	22. I assess my location on disaster scenes in terms of hazards.	0.567
	26. I adhere to the guidelines.	0.503
	58. I do not transfer my family problems to the workplace.	0.483
	59. I do not transfer my professional problems to the family environment.	0.522
Self-regulation	25. I correct my mistakes.	0.374	0.6	5.085
	34. I don’t do anything unnecessary on missions.	0.351
	40. I like teamwork.	0.391
	52. I have a good rapport with my colleagues at the workplace.	0.418
	57. My family supports me.	0.389
Job satisfaction	2. I am motivated in my job.	0.492	0.684	4.381
	15. I like to learn subjects related to my profession.	0.438
	38. I think I’ve chosen the right job.	0.611
	41. I’m satisfied with my job.	0.695

Reliability Assessment

Test-retest scores were compared based on the ICC (Table 3). Based on the findings, the entire scale has excellent consistency; one factor had an excellent lower bound, while the other factors were good.

Table 3

Reliability assessment result of firefighters occupational resilience assessment Scale
consistency	Confidence Interval (CI 95%)	(ICC)	Items No	Domain
Excellent	0.754–0.928	0.861	20	Self - efficacy
Good	0.515–0.844	0.725	7	Legality
Good	0.533–0.851	0.736	6	Organizational Trust
Good	0.591–0.868	0.767	5	Self-regulation
Good	0.586–0.866	0.764	4	Job satisfaction
Excellent	0.708–0.906	0.835	42	Total

Confirmatory factor analysis (CFA)

To investigate the goodness of fit of the final factor structure of the 42-item scale, a CFA chi-squared goodness-of-fit test was performed in LISREL 8.81. The value of this index (in Table 4) shows the acceptable and proper fit of the model.

Table 4

Fit Indicators for firefighters occupational resilience assessment model
Interpretation	Cut-Off	Value	Fit Indicator
Good	3>	2.3	CMIN/DF
Middle	0.08>	0.083	RMSEA
Good	≥ 0.95	0.91	GFI
Good	≥ 0.90	0.82	AGFI
Good	≥ 0.9	0.92	CFI
Good	≥ 0.9	0.89	NFI
Good	≥ 0. 5	0.91	NNFI
Middle	≥ 0.9	0.80	PNFI
Good	≥ 0.9	0.92	IFI
Good	0 < RFI < 1	0.88	RFI
Good	< 0.05	0.079	RMR

This study aimed to develop a new instrument for measuring firefighters’ occupational resilience. Although there are numerous specialized instruments and standards for firefighting, none of them has comprehensively evaluated physical, mental, occupational, and organizational traits and abilities. Based on the literature, several factors specify resilience: positive self-esteem, tenacity, strong coping skills, unity, optimism, self-efficacy, strong social resources, adaptability, risk-taking, little fear of failure, determination, perseverance, and high ambiguity tolerance [27]. As demonstrated herein, resilience is a multi-dimensional concept. The primary tool was developed based on a systematic review and a conventional content analysis on evaluating the factors affecting occupational resilience in Iran. The instrument underwent psychometric evaluation, including quantitative and qualitative face validity, qualitative and quantitative content validity (CVR and CVI), construct validity and reliability assessment. Construct validity was assessed via EFA with Varimax rotation. Based on the EFA results, the scree plot, the cumulative variance percentage, and the KMO diagram, this 42-item instrument has five factors self-efficacy, self-regulation, organizational trust, job satisfaction, and legality. The factors were labeled based on the categories and sub-categories extracted from the systematic review and qualitative study. The instrument was finalized after the CFA.

The first dimension of the instrument, i.e., self-efficacy, contains the majority of the items (20) with a Cronbach's alpha of 0.924. The large number of items in this domain reveals that self-efficacy plays a major role in firefighters’ resilience. Most of these items are related to personality traits and skills that make the greatest contribution to firefighters’ resilience. Personality traits are mental characteristics explaining people's behavior and determining their emotional, behavioral, and cognitive styles [28]. The interrelationship between professional skills and resilience has been reported in the literature; in fact, people who possess professional skills have greater resilience in emergencies [29].

Firefighting is a stressful job. They must be able to tolerate highly stressful scenes; perform well under these conditions, and make the right decisions [30]. According to a participant in the qualitative study, in the Plasco Building fire, several firefighters who saw the collapse of stairs decided to come down from the building’s facade, which saved their lives. This is an example of the right decision-making in difficult and stressful situations. Resilience is boosted with high exposure [31]. In some fire stations, there are few fire alarms; as such, some firefighters have limited exposure, do not possess experiential skills, or cannot correctly use the equipment because of low experience. On the other hand, in areas with a high degree of exposure to disasters, e.g., stations located in the Tehran Bazaar, the high level of exposure has raised the risk of injury or even casualty. In these areas, firefighters run the risk of job-related depression and low spirits [32]. As the nature of hazards differs across stations, firefighters should be rotated among different stations to reduce the work pressure, which needs correct managerial decisions to promote firefighters’ professional skills. Firefighters must also possess time management skills to decide when to escape the disaster and to know when the oxygen in the oxygen cylinder ends to save their own lives.

The observance of law dimension denotes firefighters’ adherence to safety rules and regulations, including the use of PPE, listening to commands, caution, hazard assessment, adherence to guidelines, and not transferring occupational problems to their family environment. People who have a low-risk perception, do not use PPE, and do not follow the guidelines are more vulnerable, a finding that is consistent with the literature [33–35].

The organizational dimension mostly involves organizational support. People who receive organizational support can use welfare and financial facilities and are, therefore, more motivated and eager to work [36]. People who are financially supported are less likely to look for a second job. On the other hand, those who work two jobs have little time to rest; their demanding second job may be tiresome; they may transfer the fatigue to the workplace, and thus fail to recover [36].

The self-regulation dimension encompasses correcting one's mistakes, not engaging in unnecessary tasks, teamwork ability, good rapport with colleagues, and the family's support. Self-regulation bridges personality and job performance. Those with higher self-regulation perform better at their jobs and can accomplish their tasks thanks to their relationships and emotional control [37].

Employees who are more satisfied with their jobs have a positive perception of the safe environment, are more committed to observing safety, and thus experience fewer injuries[19]. These employees also have a higher job motivation and perform their job with great enthusiasm and interest [38]. They, therefore, suffer fewer injuries and have greater resilience.

Based on the findings of the current study, the indicators affecting firefighters’ resilience and safe performance can be divided into five domains of self-regulation, self-efficacy, legality, organizational trust, and job satisfaction. Consequently, all the aspects of firefighters’ competency must be considered when evaluating, planning, and enhancing their resilience. A deficiency in any dimension may lead firefighters to undertake unsafe measures. These domains and indicators must be used to development of comprehensive instruments and interventions to promote firefighters’ resilience. Based on the results, the entire scale enjoys excellent consistency. Furthermore, in the test-retest stage, the measured variables/concepts and the sample's characteristics remained stable over time.

By using systematic approaches, this study developed a self-assessment tool to allow firefighters to measure their resilience. As only subjective items were included in this instrument, future studies should include measurable objective items, such as physical preparedness and health, mental health, and personality traits. Future studies can also examine the importance and priority of each of these items via the Delphi method.

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Ethical approval

This research was one phase of a Ph.D. dissertation in the field of Health in Disaster and Emergency in the Public Health Faculty of Tehran University of Medical Sciences. Also, this study has ethical approval from the Ethics Committee of Tehran University of Medical Sciences (code: IR. TUMS. SPH.REC.1397.240).

Consent for publication

At the beginning of the study, the participant informed about the aim of the study and respect their right to withdraw from the research at any time. Verbal informed consent was obtained. The anonymity and confidentiality were explained to all participants.

Funding

Not applicable

Author Contribution

AH and AE participated in the study design, data collection, data analysis, manuscript writing, revising, and editing. The study was done under the supervision of DKZ and AOT. All authors read, revised and approved the final manuscript.

Acknowledgements

Not applicable

Availability of data and materials

Not applicable

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No competing interests reported.

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Development and psychometric evaluation of a new instrument for firefighter’s occupational resilience assessment: An exploratory mixed-methods study

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Version 1

Abstract

Figures

Introduction

Materials and Methods

Phase 1: Item generation and questionnaire design

Item generation

Questionnaire development

Psychometric evaluation

Face validity

Qualitative face validity

Quantitative face validity

Impact Score = Frequency (%) × Importance

Phase 2: Content validity

Qualitative content analysis determination

Quantitative content analysis determination

Content Validity Ratio

Content Validity Index

Construct validity examination

Exploratory factor analysis (EFA)

Instrument reliability

Confirmatory factor analysis (CFA)

Results

Item generation results

Validity evaluation results

CVR and CVI

Construct validity examination

Exploratory factor analysis (EFA)

Reliability Assessment

Confirmatory factor analysis (CFA)

Discussion

Conclusion

Limitations

Declarations

Ethical approval

Funding

Author Contribution

Acknowledgements

Availability of data and materials

References

Additional Declarations

Status:

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