Asserting the Construct Validity of the Professional Quality of Life (ProQOL) measurement instrument
October 1, 2019
Clinicians who work with traumatized individuals often find positive meaning in their work and yet a high percentage of them remain vulnerable to burnout or traumatic stress. For this reason, many scientists have sought to develop scales to help them and others assess symptoms. Measuring how clinicians are impacted by their work is no easy challenge. To do so, many researchers turn to the Professional Quality of Life (PROQOL) scale developed by Stamm (2010), a widely used questionnaire to measure Compassion Satisfaction (CS) and Compassion Fatigue (CF). CS is referred to as the feeling of joy clinicians get from helping others while CF refers to a combination of both burnout (i.e., feeling trapped, overwhelmed and bogged down by the system) and secondary traumatic stress (i.e., feeling preoccupied, scared or on edge because of thoughts of clients’ stories).
The latest version of the scale is the PROQOL 5, a self-report instrument comprised of three different 10–item subscales (i.e., burnout, secondary traumatic stress and satisfaction). Each item assesses how frequently in the last 30 days the respondents experienced symptoms using a 5-point scale (1= never to 5 = very often). Yet despite the scale’s popularity, the PROQOL’s psychometric properties remain nebulous and there is currently not enough publicly available evidence to confirm its validity. This means that, despite its popular use, researchers and clinicians still cannot say if the scale is interpreted in the same manner by respondents, if the three scales are conceptually-linked, or if its scores are related in a logical manner to other clinical concepts (e.g., psychological wellbeing should be related to CS).
Our study conducted among a sample of 310 child protection workers sought to investigate this question using specialized statistical techniques to validate the scale. To do so, we used the French version of the PROQOL 5 translated and promoted by Stamm. Our factorial analysis failed to confirm the adequacy of the three-factor structure (i.e., CS, burnout and secondary traumatic stress). This means that when we investigated the statistical links between each item, the best statistical solution could not group the burnout items together as a whole, and the same with the other two concepts. Instead, we found a bifactor model fostering a general factor computing the PROQOL’s 30 items that accounted for almost half of the common variance of the PROQOL, suggesting unidimensionality of the scale. And so, the PROQOL could be used as a continuous scoring instrument, rather than three separate subscales. Still, our analyses revealed that each subscale could be used separately, but with less reliability and explained common variance. This is very similar to PTSD scales that give clinicians a single score, while simultaneous allowing them to isolate a score for a specific cluster of symptoms (e.g., hypervigilance). The continuous score was also closely and conceptually linked to the Post-Traumatic Disorder (PTSD) checklist and a scale of well-being at work and a scale of psychological distress at work (i.e., adequate convergent validity). We expected such close associations since secondary traumatic and PTSD are similar in a conceptual sense and so are well-being at work and CS. And yet, the general score was not associated with the Life Event Checklist indicating that the general score obtain truly refers the intent of the PROQOL and not another concept such as traumatic events (i.e., good discriminant validity).
Overall, our study indicated that CS and CF represent higher and lower levels of the same construct rather than two different constructs. The compassion framework should then be interpreted as a response continuum to work-related stress ranging from fatigue to satisfaction thereby reflecting the counterbalancing of negative and positive outcomes. We suggest therefore, that people are either in a state of CF or CS but cannot be experiencing both. This refutes the original idea that a clinician could obtain a high score on all three subscales (i.e. burnout + secondary traumatic stress + compassion satisfaction).
Based on our results, it appears that this instrument is an appropriate tool to assess the professional quality of life of clinicians. A general scale reflecting a continuum ranging from low PROQOL (i.e., CF) to high PROQOL (i.e. CS) is an asset for any clinician wishing to measure this concept since a single score is easier to grasp, use, and calculate. The use of a continuum ranging from CF to CS will undoubtedly help clinicians increase the accuracy of their clinical assessments. Yet, if needed, the bifactor structure still allows for the scoring of CS, burnout and secondary traumatic stress individually as proposed by Stamm (2010). Although our study represents an essential first step toward improved accuracy but since we used a sample of child protection workers only; we recommend that our results be replicated with professionals from different fields before stating that the scale is valid in all circumstances. Nonetheless, it is encouraging to see that such a widely used questionnaire holds up when tested by advanced statistical techniques. In the end, we hope that our findings will play an important role in promoting the psychological resilience of clinicians with more accurate screening instruments. For more questions, feel free to write us.
Stamm, B. H. (2010). The concise ProQOL manual. Pocatello, ID: ProQOL. org. Retrieved from http://ProQOL.org/uploads/ProQOL_Concise_2ndEd_12-2010.pdf
Geoffrion, S. , Lamothe, J. , Morizot, J. and Giguère, C. (2019), Construct Validity of the Professional Quality of Life (ProQoL) Scale in a Sample of Child Protection Workers. JOURNAL OF TRAUMATIC STRESS, 32: 566-576. doi:10.1002/jts.22410
Questions For Discussion
- Once a clinician has been deemed at serious risk of experiencing compassion fatigue, what would be the most appropriate steps for their employers to take before opting for sick leaves?
- What kind of work environments are more likely to foster compassion satisfaction and hinder compassion fatigue?
About the Authors
Steve Geoffrion, Ph.D. is an Assistant Professor in Psychoeducation at Université de Montréal and co- director at the Trauma Studies Center of the Montreal University Mental Health Institute. With his past funded research on workers’ traumatic exposure in healthcare settings, he has dedicated the past years to developing an expertise on the prevention of traumatic events at work and coping strategies according to sex and gender. His current projects aim to adapt, implement and assess the efficacy of Psychological First Aid in healthcare settings and among public safety personnel.
Josianne Lamothe, MSW, is a PhD student in criminology at the Université de Montréal, Canada. She is also a Student Perspectives Contributor for StressPoints. Her research interests are workplace violence, worker resilience and trauma, and client outcomes.