Assessing ambulance staff attitudes toward mental health conditions: translation and psychometric evaluation of the medical condition regard scale among ambulance staff

Introduction: Ambulance staff play a crucial role in responding to mental health crises. However, negative regard toward patients with mental health conditions can hinder care. The Medical Condition Regard Scale (MCRS) assesses regards or attitudes but has not previously been validated for educated ambulance staff and has never been translated into Norwegian. This study aims to translate the instrument into Norwegian, test it on a population of ambulance staff, explore the psychometric properties of the Norwegian version, and measure regard for patients with psychosis.

Method: The MCRS is an 11-item instrument with a Likert scale of 1-6. Possible sum scores range from 11 to 66 (higher score = more positive regards). We chose "psychosis" as the condition to investigate. Translation followed eight steps: (1) preparation, (2) forward translation, (3) backward translation, (4) first expert panel review, (5) harmonisation, (6) cognitive debriefing, (7) second expert panel review, and (8) writing of the final version. The instrument was tested and re-tested regarding the condition "psychosis" on a representative sample of 114 Norwegian ambulance staff in 2023, with a temporal gap of one month. We explored item scores and distribution, as well as floor and ceiling effects. We tested the internal consistency of the items using Cronbach's Alpha and consistency in answers over time (test and re-test) using the Paired Sample-T test. We used factor analyses to explore the inter-item relationships of the items.

Results: The 114 participants had a mean sum score of 47, which is mid-range. The scale has a ceiling effect on five items, which was not described in detail earlier. Two items regarding the monetary spending on patients with the given condition had the largest ceiling effects. However, the Norwegian translation showed adequate internal consistency (Cronbach's Alpha = 0.82) and is reliable over time. Test and re-test showed no significant differences in the scale's total score (Paired sample T-test, p > 0.05). Exploratory and confirmatory factor analyses indicate that the scale should be used as a one-dimensional instrument in a Norwegian setting in ambulance staff populations.

Conclusion: The Norwegian translation of the MCRS is a reliable instrument for ambulance staff measuring medical condition regards. However, the ceiling effect limits the ability to discern differences among high-scoring individuals. Ambulance staff's regard for patients with psychosis is medium positive (mid-range level), but slightly more positive than what is reported in the international literature regarding patients with mental health issues.