Luppo Kuillman

Re-assessing the validity of the Moral Sensitivity Questionnaire 51 2 Appendix 1: Instruments used for testing convergent and divergent validity Behavioral Control targeted at Preventing Harm (BCPH) scale According to Ajzen, “perceived behavioral control” entails the ease or difficulty that a person experiences in performing a certain behavior. Based on the Hippocratic principle of “First, do no harm,” a tool to measure this was required. This was operationalized by employing the concept of “Perceived Control of Preventing Harm.” The result was the development of the “Behavioral Control targeted at Preventing Harm” (BCPH) scale, consisting of five items: 1) “I always feel responsible for proper patient care, even if the resources are insufficient”; 2) “My skill in assessing the needs of the patient always helps me in my work”; 3) “I can always properly assess whether and when a patient should be told the truth”; 4) “I can easily sense when a patient is not receiving proper care”; and 5) “In patient care, I am always aware of the balance between performing the task well and the risk of harm to the patient.” Items were answered on a 7-point Likert scale equivalent to the MSQ items. Principal Component Analysis with Varimax rotation demonstrated that the BCPH was unidimensional, with factor loadings ranging from 0.54 to 0.83. The BCPH Cronbach’s alpha yielded 0.72. Index scores were calculated using the algorithm as employed for the MSQ, with higher scores indicating a stronger behavioral control of abstaining from doing harm Ethics Advocacy Scale (EAS) The EAS was operationalized with the intention of measuring the respondent’s attitude towards considering the moral aspects of patient-oriented care. The scale comprised three Likert-type items, from 1 (not applicable) to 5 (completely applicable), with the following items: 1) “I think it’s important – when there is a good reason to do so – to raise ethical aspects of care during patient care discussions”; 2) “I think it’s important to be alert to the ethical implications of the medical treatment I provide”; and 3) “I think it’s important for the organization where I work to explicitly focus attention on the medical and ethical aspects of care.” In addition to these three questions, a fourth semantic differential slider scale from 0 to 100 – from “completely useless” to “very meaningful” – was used, based on the question: “What is your opinion about applying ethical principles to medical care?” In order to combine the Likert-type items with the semantic differential scale questions, the first three items were also converted