Cross-cultural adaptation and psychometric refinement of the Thai Work-Related Stress Questionnaire (T-WRSQ) for registered nurses
Abstract
Background & Aim: Work-related stress can adversely affect nurses’ well-being, workforce stability, and quality of care. However, a culturally appropriate and psychometrically validated instrument for assessing psychosocial work-related stress among Thai nurses is needed. This study aimed to translate, culturally adapt, and psychometrically refine the Work-Related Stress Questionnaire (WRSQ) for Thai registered nurses.
Methods & Materials: This two-phase methodological study translated and culturally adapted the WRSQ following international guidelines. The instrument was evaluated by five experts and pilot-tested with 30 nurses. Psychometric evaluation was conducted among 276 registered nurses from Ministry of Public Health hospitals, randomly allocated to exploratory and confirmatory samples. Exploratory factor analysis (EFA) examined factor structure and item performance, followed by confirmatory factor analysis (CFA) of competing models. Convergent validity, discriminant validity, and internal consistency were assessed.
Results: The Thai WRSQ demonstrated excellent content validity (I-CVI and S-CVI/Ave = 1.00). EFA initially identified four factors broadly corresponding to the original WRSQ; however, the Job Demand domain lacked structural coherence. A revised 10-item, three-factor model excluding this domain showed the best CFA fit (χ²/df=1.66, CFI = 0.96, TLI= 0.94, RMSEA= 0.07, SRMR= 0.05). The retained domains demonstrated satisfactory convergent validity (CR= 0.79–0.85; AVE= 0.56–0.66), discriminant validity (AVE>MSV; HTMT= 0.09–0.79), and internal consistency (overall α = 0.82; ω = 0.85).
Conclusions: The revised 10-item Thai WRSQ is a valid and reliable instrument for assessing psychosocial work-related stress among Thai registered nurses.
2. Cohen C, Pignata S, Bezak E, Tie M, Childs J. Workplace interventions to improve well-being and reduce burnout for nurses, physicians and allied healthcare professionals: a systematic review. BMJ Open. 2023;13(6):e071203.
3. Babapour AR, Gahassab-Mozaffari N, Fathnezhad-Kazemi A. Nurses' job stress and its impact on quality of life and caring behaviors: a cross-sectional study. BMC Nurs. 2022;21(1):75.
4. Nantsupawat A, Poghosyan L, Wichaikhum OA, Kunaviktikul W, Fang Y, Kueakomoldej S, et al. Nurse staffing, missed care, quality of care and adverse events: A cross-sectional study. J Nurs Manag. 2022;30(2):447-54.
5. Srisintorn W, Buapeth A. Psychometric Properties of Effort-reward Imbalance Questionnaire among Nurses. Pac Rim Int J Nurs Res. 2022;26(2):228-42.
6. De Sio S, Cedrone F, Perri R, Nieto HA, Greco E, Buomprisco G, et al. Work-Related Stress Questionnaire (WRSQ): a new tool to assess psychosocial risks at workplaces. Clin Ter. 2020;171(4):e316-e20.
7. Cedrone F, Stacchini L, La Torre G, Berselli N, De Nicolò V, Caminiti M, et al. Work-Related Stress Questionnaire: confirmatory factor analysis for construct validation by the PHRASI study. Eur Rev Med Pharmacol Sci. 2024;28(1):392-401.
8. Phakthongsuk P. Construct validity of the Thai version of the job content questionnaire in a large population of heterogeneous occupations. J Med Assoc Thai. 2009;92(4):564-72.
9. Buapetch A, Lagampan S, Faucett J, Kalampakorn S. The Thai version of Effort-Reward Imbalance Questionnaire (Thai ERIQ): a study of psychometric properties in garment workers. J Occup Health. 2008;50(6):480-91.
10. Milo RB, Ramira A, Peppard S, Ramira MLB, Brown R, Soon K, et al. A Systematic Review of the Non-English Versions of the Perceived Stress Scale (PSS)-10 Psychometric Analysis. SAGE Open Nurs. 2025;11:23779608251377287.
11. Cruchinho P, López-Franco MD, Capelas ML, Almeida S, Bennett PM, Miranda da Silva M, et al. Translation, Cross-Cultural Adaptation, and Validation of Measurement Instruments: A Practical Guideline for Novice Researchers. J Multidiscip Healthc. 2024;17:2701-28.
12. Beaton DE, Bombardier C, Guillemin F, Ferraz MB. Guidelines for the process of cross-cultural adaptation of self-report measures. Spine (Phila Pa 1976). 2000;25(24):3186-91.
13. Burnard P, Naiyapatana W. Culture and communication in Thai nursing: a report of an ethnographic study. Int J Nurs Stud. 2004;41(7):755-65.
14. Posai V, Jitpanya C, Srisintorn W, Thongsuksai P. Cultural Adaptation and Psychometric Validation of a Thai Version of the Turnover Intention Scale (T-TIS) for Thai Nursing Professionals. Nurs Open. 2026;13(8):e70729.
15. Posai V, Srisintorn W, Thongsuksai P, Jitpanya C. Thai Burnout Assessment Tool (T-BAT): Translation, validity, and reliability testing in nurses. Belitung Nurs J. 2025;11(5):602-11.
16. Roussos PL. The Psychosocial Risks and Impacts in the Workplace Assessment Tool: Construction and Psychometric Evaluation. Behav Sci (Basel). 2023;13(2).
17. Gagnier JJ, Lai J, Mokkink LB, Terwee CB. COSMIN reporting guideline for studies on measurement properties of patient-reported outcome measures. Qual Life Res. 2021;30(8):2197-218.
18. Brislin RW. Back-translation for cross-cultural research. J Cross Cult Psychol. 1970;1(3):185-216.
19. Wolf EJ, Harrington KM, Clark SL, Miller MW. Sample Size Requirements for Structural Equation Models: An Evaluation of Power, Bias, and Solution Propriety. Educ Psychol Meas. 2013;76(6):913-34.
20. Mokkink LB, Herbelet S, Tuinman PR, Terwee CB. Content validity: judging the relevance, comprehensiveness, and comprehensibility of an outcome measurement instrument - A COSMIN perspective. J Clin Epidemiol. 2025;185:111879.
21. Hair JF, Black WC, Babin BJ. Multivariate Data Analysis: A Global Perspective. Upper Saddle River, NJ: Pearson Education; 2010.
22. Kim HY. Statistical notes for clinical researchers: Assessing normal distribution (2) using skewness and kurtosis. Restor Dent Endod. 2013;38(1):52-4.
23. Watkins MW. Exploratory Factor Analysis: A Guide to Best Practice. J Black Psychol. 2018;44(3):219-46.
24. Li CH. Statistical estimation of structural equation models with a mixture of continuous and categorical observed variables. Behav Res Methods. 2021;53(5):2191-213.
25. Goretzko D, Siemund K, Sterner P. Evaluating Model Fit of Measurement Models in Confirmatory Factor Analysis. Educ Psychol Meas. 2024;84(1):123-44.
26. Morera OF, Stokes SM. Coefficient α as a Measure of Test Score Reliability: Review of 3 Popular Misconceptions. Am J Public Health. 2016;106(3):458-61.
27. Zijlmans EAO, Tijmstra J, van der Ark LA, Sijtsma K. Item-Score Reliability as a Selection Tool in Test Construction. Front Psychol. 2018;9:2298.
28. Thi Dung N, Miranda H, María R-M, Thi Kim Chi L, Thi Thanh Truc N, Hong Thiep N, et al. Cross-cultural adaptation and psychometric validation of the Vietnamese version of the evidence-based practice competency questionnaire for registered nurses (EBP-COQ Prof©). Nurs Pract Today. 2023;10(3).
29. Bakker AB, Demerouti E. Job demands-resources theory: Frequently asked questions. J Occup Health Psychol. 2024;29(3):188-200.
30. Badolamenti S, Biagioli V, Zaghini F, Caruso R, Sili A. Development and validation of Emotional Labour in Nursing Scale in Italy. Med Lav. 2018;109(6):444-58.
31. Posai V, Srisintorn W, Thongsuksai P, Jitpanya C. Psychometric evaluation of the Thai version of Emotional Labor Scale (T-ELS) in Thai nurses. J Health Res . 2025;39(3):290-8.
| Issue | Articles in Press | |
| Section | Original Article(s) | |
| Keywords | ||
| work-related stress; registered nurses; cross-cultural adaptation; factor analysis; psychometric refinement | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |



