Italian validation of the Measure of Moral Distress for Healthcare Professionals (MMD-HP): A multicenter cross-sectional study

BackgroundMoral distress occurs when ethically appropriate actions cannot be implemented, resulting in cognitive and emotional strain linked to outcomes like burnout and staff turnover. Despite extensive cross-cultural validation of the Measure of Moral Distress for Healthcare Professionals (MMD-HP), no Italian adaptation currently exists, limiting research in Italian contexts.AimTo culturally adapt and validate the Italian version of the Measure of Moral Distress for Healthcare Professionals (MMD-HP-ITA) within two major Italian healthcare settings.MethodsAn observational multicenter cross-sectional study was conducted from December 2022 to September 2023. The original questionnaire underwent forward-backward translation. Confirmatory and exploratory factor analyses evaluated structural validity, and Cronbach's alpha assessed internal consistency. Construct validity was tested by correlating scores with the Ethical Leadership Scale.ParticipantsA sample of 567 healthcare professionals (median age 43 years; 74% female; 74% nurses) was recruited and completed the Italian version of the questionnaire online.Ethical considerationThe study was approved by the Ethics Committees of the two healthcare institutions involved. Informed consent was obtained from all participants.ResultsThe Italian version demonstrated strong internal consistency (Cronbach's α = 0.96). Exploratory factor analysis supported a three-factor model explaining 58.6% of the variance, with dimensions reflecting: (1) System-level constraints, (2) Team-level dynamics, and (3) Patient/family-level conflicts. Convergent validity was confirmed via significant associations with related constructs: moral distress scores were higher among nurses, younger professionals, and those considering job departure, and negatively correlated with ethical leadership ratings (r = -0.375, <i>p</i> < 0.001).ConclusionThe Italian version of the Measure of Moral Distress for Healthcare Professionals is a reliable and valid instrument for assessing moral distress among Italian healthcare professionals, effectively capturing the multidimensionality of the construct in a culturally relevant way.