Modelling the multidimensional structure of workplace violence against emergency medical technicians and mitigation strategies in Ghana: a confirmatory factor analysis

BACKGROUND: Emergency Medical Technicians (EMTs) are routinely exposed to workplace violence, yet empirical evidence from low- and middle-income countries remains limited. This study examined the multidimensional structure of workplace violence against EMTs in Ghana, evaluated perceived mitigation strategies using a confirmatory factor analysis (CFA) approach and explored EMTs' perceptions of workplace violence mitigation strategies. METHODS: A cross-sectional survey was conducted among 336 EMTs across three regions of Ghana. Workplace violence was measured using 23 items, and mitigation strategies using 10 items. A two-step approach was employed: an exploratory factor analysis (EFA) to ascertain the underlying factor structure, followed by CFA to validate the identified structure from the EFA. We used a weighted least-squares mean-and-variance-adjusted estimator appropriate for ordinal data. Model reliability, convergent validity, and inter-construct relationships were assessed. RESULTS: The CFA supported a three-factor structure comprising verbal/non-physical abuse, physical assault, and severe violent attacks, with strong internal consistency (α = 0.812-0.939) and high convergent validity (AVE > 0.75). The study revealed strong structural covariance between physical assault and severe violent attacks (r = 0.668), moderate covariance between physical assault and verbal abuse (r = 0.439), and weaker but significant covariance between severe attacks and verbal abuse (r = 0.347). Most respondents (84%) expressed high concern about workplace violence. Aggression management, defensive tactical training, and resilience training were perceived as the most effective mitigation strategies. CONCLUSION: Workplace violence against EMTs in Ghana is multidimensional and highly interrelated. Interventions should prioritize early de-escalation, organizational protection mechanisms, and national EMS violence-prevention policies. Addressing verbal and physical abuse concurrently may prevent escalation into severe violence.