Design and psychometric testing of a moral intelligence instrument for pre-hospital emergency medical services personnel: a sequential-exploratory mixed-method study.

Background: Moral intelligence is a significant and influential factor in the delivery of principled and high-quality care. This is because moral intelligence is the ability to recognize and be sensitive to moral issues, which contributes to the organization of appropriate behavior in the face of moral issues. This is particularly pertinent given that pre-hospital emergency medical services personnel (prehospital EMS personnel) frequently encounter stressful and tension-filled situations. Thus, intelligent reasoning and ethical conduct at the scene of an incident are of paramount importance. Also, there is no special tool available for measuring the moral intelligence of prehospital EMS personnel. Hence, there is a necessity for the design and psychometric evaluation of a specialized instrument to assess the moral intelligence of prehospital EMS personnel with a sequential exploratory approach. Accordingly, the present study was conceptualized and implemented with the objective of designing and psychometrically evaluating an instrument for measuring the moral intelligence of prehospital EMS personnel.

Methods: This study employed a mixed-methods design with a sequential exploratory approach. The research was executed in two distinct phases. In the first phase, a conventional content analysis method was utilized to explore narratives expressed by 34 prehospital EMS personnel. It was in the second phase where the psychometric properties including face validity, content validity, construct validity and reliability were measured. A total of 210 prehospital EMS personnel participated for exploratory and confirmatory factor analysis. Kaiser-Meyer-Olkin, Bartlett's tests, Cronbach's alpha coefficient, as well as test-retest were used for data analysis.

Results: The moral intelligence of prehospital EMS personnel was conceptualized as emotional stability coupled with intelligent reasoning, oriented towards the provision of ethical care and moral courage in patient advocacy. In the exploratory factor analysis (EFA) phase, the questionnaire was distilled into three dimensions: "Emotional stability combined with intelligent reasoning" (11 items), "Ethical care" (12 items), and "Ethical courage" (7 items), accounting for 74.38% of the observed variance. Confirmatory validity also confirmed the structure of the tool obtained from the previous step. The instrument's reliability, as assessed by Cronbach's alpha coefficient, was reported at 0.95 for the entire scale.

Conclusion: The Moral Intelligence Scale for prehospital EMS personnel demonstrated acceptable psychometric properties. Consequently, healthcare administrators may employ this instrument to assess moral intelligence in prehospital EMS personnel. Furthermore, when deemed necessary, they can identify and implement the most appropriate strategies, including educational interventions, to enhance moral intelligence among prehospital EMS personnel. Thus, it is suggested that future studies explore the psychometric properties of this tool with a larger sample size and in different cultures.