CC BY
33
Received: 29 January 2021 / Accepted: 11 April 2021 / Published online: 30 April 2021
DOI 10.34689/SH.2021.23.2.014 UDC 159.913:378
ADAPTATION AND VALIDATION OF THE RUSSIAN VERSION OF THE OLDENBURG BURNOUT INVENTORY AMONG MEDICAL STUDENTS
Aidos K. Bolatov1, https://orcid.org/0000-0002-5390-4623 Dariga S. Smailova2, https://orcid.org/0000-0002-7152-7104 Meiramgul D. Zhorokpayeva3, https://orcid.org/0000-0001-9101-654X Akhat D. Amanzholov3, https://orcid.org/0000-0002-5393-4187 Telman Z. Seisembekov1, https://orcid.org/0000-0002-2129-7128
1 N^SC «Astana Medical University», Nur-Sultan c., Republic of Kazakhstan;
2 Kazakhstan's Medical University «Kazakhstan School of Public Health», Almaty, Republic of Kazakhstan;
3 N^SC «Semey Medical University», Semey c., Republic of Kazakhstan.
Abstract
Aim: This paper aims to describe the psychometric properties of the Russian version of the Oldenburg Burnout Inventory (R-OLBI-S) adapted for students in Kazakhstan.
Methods: A cross-sectional study was carried out at the NpJSC "Astana Medical University between October and December 2019. In total, 696 medical students responded. The survey was anonymous and administered via a link to an electronic form. The study included R-OLBI-S and Copenhagen Burnout Inventory to measure burnout. Statistical analyses included frequency and confirmatory factor analysis, convergent and discriminant validity, and reliability analysis.
Results: The R-OLBI-S demonstrated good reliability and validity. Cronbach's alpha coefficient was 0.858, KMO = 0.886. R-CBI-S achieved good levels of goodness-of-fit indices (x2/df = 2.38, p < 0.001, CFI = 0.986, TLI = 0.979, SRMR = 0.023, RMSEA = 0.045). Convergent validity evidence showed AVE = 0.50 and CR = 0.80 for Disengagement subscale, AVE = 0.57, CR = 0.84 for Exhaustion subscale. The R-OLBI-S demonstrated good reliability and validity. The prevalence of burnout among students was 31 %.
Conclusions: The adapted and validated Russian version of OLBI-S (R-OLBI-S) is a reliable tool for diagnosing burnout syndrome in students.
Key words: burnout syndrome, OLBI, medical students, Kazakhstan.
Резюме
АДАПТАЦИЯ И ВАЛИДИЗАЦИЯ РУССКОЯЗЫЧНОЙ ВЕРСИИ ОЛЬДЕНБУРГСКОГО ОПРОСНИКА ВЫГОРАНИЯ У СТУДЕНТОВ-МЕДИКОВ
Айдос К. Болатов1, https://orcid.org/0000-0002-5390-4623 Дарига С. Смаилова2, https://orcid.org/0000-0002-7152-7104 Мейрамгул Д. Жорокпаева3, https://orcid.org/0000-0001-9101-654X Ахат Д. Аманжолов3, https://orcid.org/0000-0002-5393-4187 Тельман З. Сейсембеков1, https://orcid.org/0000-0002-2129-7128
1 НАО «Медицинский университет Астана», г. Нур-Султан, Республика Казахстан;
2 Казахстанский медицинский университет «Высшая школа общественного здравоохранения», г. Алматы, Республика Казахстан;
3 НАО «Медицинский университет Семей», г. Семей, Республика Казахстан.
Цель: В статье описываются психометрические характеристики русскоязычной версии Ольденбургского опросника выгорания (R-OLBI-S).
Методы: Поперечное исследование было проведено в НАО «Медицинский университет Астана» в период с октября по декабрь 2019 года. Всего приняло участие 696 студентов-медиков. Опрос проводился анонимно, используя ссылку на электронную форму. Исследование включало следующие шкалы для измерения выгорания: R-OLBI-S и Копенгагенский опросник выгорания. Статистические методы: частотный и конфирматорный факторный анализ, анализ конвергентной и дискриминантной достоверности и анализ надежности.
Результаты: Коэффициент альфа Кронбаха составил 0,858, KMO = 0,886. R-CBI-S достиг хороших уровней показателей согласия (x2/df = 2,38, p<0,001, CFI = 0,986, TLI = 0,979, SRMR = 0,023, RMSEA = 0,045). Анализ конвергентной валидности показал, что AVE = 0,50 и CR = 0,80 для подшкалы «Отстраненность», AVE = 0,57, CR =
0,84 для подшкалы «Истощение». R-OLBI-S продемонстрировал хорошую надежность и валидность. Распространенность выгорания среди студентов составила 31%.
Заключение: Адаптированная и валидизированная русскоязычная версия OLBI-S (R-OLBI-S) является надежной методикой диагностики синдрома выгорания у студентов.
Ключевые слова: синдром выгорания, OLBI, студенты медики, Казахстан.
Туйшдеме
МЕДИЦИНА СТУДЕНТТЕР1 АРАСЫНДА ОЛДЕНБУРГ КУЙ1П КАЛУ САУАЛЫМАСЫН ОРЫС Т1Л1НЕ АДАПТАЦИЯЛАУ ЖЭНЕ ВАЛИДИЗАЦИЯЛАУ
Айдос К. Болатов1, https://orcid.org/0000-0002-5390-4623
Дарига С. Смаилова2, https://orcid.org/0000-0002-7152-7104
Мейрамгул Д. Жорокпаева3, https://orcid.org/0000-0001-9101-654X
Ахат Д. Аманжолов3, https://orcid.org/0000-0002-5393-4187
Тельман З. Сейсембеков1, https://orcid.org/0000-0002-2129-7128
1 «Астана медицина университет» КеАК, Нур-Султан к-, Казахстан Республикасы; 2Казакстандык медицина университетi «Когамдык денсаулык сактау жогары мектебi»; 3 «Семей Медицина университетi» КеАК, Семей к-, Казахстан Республикасы.
Максат: Осы макалада ^азакстан студенттерiне бейiмделген Олденбург ^йт калу сауалнамасыныщ (R-OLBI-S) орыс нускасыныщ психометриялык касиеттерЫ сипатталды.
Эд1стер: 2019 жылдыщ казан айынан бастап желтоксан айына дейiн Астана медициналык университетще кималык зерттеу жYргiзiлдi. Барлыгы 696 медицина студенттерi катысты. Сауалнама жасырын болды жэне электрондык формага сттеме аркылы жYргiзiлдi. Зерттеуде келесi ^йт калуды елшеу куралдары колданды: R-OLBI-S жэне Копенгаген кYЙiп калу сауалнамасы. Статистикалык эдiстер жиiлiктi жэне конфирматорлы факторлык талдауды, конвергенттi жэне дискриминантты жарамдылыкты жэне сенiмдiлiк талдауларын камтыды.
Нэтиже: Кронбахтыщ альфасы 0,858, KMO = 0,886 курады. R-CBI-S келгамнщ жаксы де^гейлерЫе кол жетад (X2/df = 2,38, p <0,001, CFI = 0,986, TLI = 0,979, SRMR = 0,023, RMSEA = 0,045). Конвергентт жарамдылыкты талдау «Шеттелу» ш шкаласы Yшiн AVE = 0.50 жэне CR = 0.80, «Таусылу» кiшi шкаласы Yшiн AVE = 0.57, CR = 0.84 керсетп. R-OLBI-S сенiмдiлiгiн мен жарамдылыгын керсеттi. Студенттер арасында ^йт калудыщ таралуы 31% курады.
Корытынды: OLBI-S (R-OLBI-S) адаптацияланган жэне валидизацияланган орыс нускасы студенттерде кYЙiп калу синдромын диагностикалаудыщ сенiмдi куралы болып табылады.
TYurndi свздер: куйт к,апу синдромы, OLBI, медицина студенттер'!, Казахстан.
Bibliographic citation:
Bolatov A.K., Smailova D.S., Zhorokpayeva M.D., Amanzholov A.D., Seisembekov T.Z. Adaptation and validation of the Russian version of the Oldenburg burnout inventory among medical students // Nauka i Zdravookhranenie [Science & Healthcare]. 2021, (Vol.23) 2, pp. 133-139. doi 10.34689/SH.2021.23.2.014
Бопатов А.К., Смаипова Д.С., Жорокпаева М.Д., Аманжопов А.Д., Сейсембеков Т.З. Адаптация и валидизация русскоязычной версии Ольденбургского опросника выгорания у студентов-медиков // Наука и Здравоохранение. 2021. 2(Т.23). С. 133-139. doi 10.34689/SH.2021.23.2.014
Бопатов А.К., Смаипова Д.С., Жорокпаева М.Д., Аманжопов А.Д., Сейсембеков Т.З. Медицина студент^ арасында Олденбург ^йт калу сауалымасын орыс ттше адаптациялау жэне валидизациялау // Гылым жэне Денсаулык сактау. 2021. 2 (Т.23). Б. 133-139. doi 10.34689/SH.2021.23.2.014
Introduction
Burnout is a syndrome of exhaustion, depersonalization, and decreased professional performance that occurs among employees working in social fields, like healthcare, education, and others [11]. At the same time, researchers began to investigate the phenomenon of emotional burnout in students [8,12]. Given that the structure of the activities that students are involved in, as well as the characteristics of the tasks that they have to perform, closely resemble those of many professions, for example, students must attend classes and achieve certain goals, such as passing exams [15], it is likely that students
also feel exhausted and may develop a detachment from their studies [14].
Equivalent to employee burnout, student burnout has been defined as a three-dimensional syndrome that is characterized by a sense of exhaustion due to study requirements, a special attitude of detachment, and a decrease in personal effectiveness with academic requirements [15]. Given how long it takes for burnout symptoms to disappear [19], it is likely that academic burnout symptoms will still be present when students start their careers as first-time employees and young professionals. Thus, it is important to investigate the
phenomenon of professional burnout in students; since there is evidence that professional burnout follows a developmental process that may have already been initiated during students ' studies [6].
In most studies, academic burnout was measured using the Maslach Burnout Inventory-General Survey (MBI-GS) [16], adapted for students (MBI-SS) [15]. The main drawback of this approach is that it was automatically assumed that the concept of "burnout" for employees is equivalent to the concept of "burnout" for students. In other words, it is taken for granted that employees and students refer to the same experience when evaluating professional and academic burnout, respectively. However, there is still no convincing evidence for this assumption.
Besides, the psychometric indicators of MBI-GS are criticized, since this scale measures only affective exhaustion [9]. Given these circumstances, it was decided to use an alternative tool for detecting burnout syndrome in students - the Oldenburg Burnout Inventory (OLBI) [4], which was originally developed to overcome most of the limitations of MBI-GS [2,3]. To study academic burnout
Socio-demographic characteristics of participants (N = 696 .
Measures
The socio-demographic characteristics of the participants were assessed through a custom-built questionnaire. To assess burnout the OLBI-S, through the
The OLBI-S original and Russian version (R-OLBI-S)
Demerouti et al (2010) developed an OLBI version for students (OLBI-S) [5].
Since the phenomenon of burnout is little studied among students in Kazakhstan, the aim of the study is to adapt and validate the Russian version of OLBI-S for the diagnosis of burnout syndrome in students.
Materials and Methods
Study design
This was a cross-sectional study carried out in Astana Medical University (AMU) during the period October -December 2019.
Participants
Participants were invited via messengers and University Informational portal "Sinus" to self-complete an online survey created by the 1ka platform (www.1ka.si). Participation was anonymous and voluntary. 696 students from 1928 respondents completed the questionnaire (response rate 36%). The average age of the total sample was 19.98 years (SD = 2.50), with 75% being female. Table 1 presents the baseline socio-demographics of participants.
Table 1.
development of a Russian-version adapted for Kazakhstan (R-OLBI-S; Table 2), and the Copenhagen Burnout Inventory for college students (CBI-S).
Table 2.
Item Original OLBI-S Russian version of OLBI (R-OLBI-S)
Strongly Agree Disagree Strongly Полностью Согласен Не согласен Полностью не
agree disagree согласен согласен
1 2 3 4 1 2 3 4
Disengagement Отстраненность
1 I always find new and interesting aspects in my studies *Я всегда нахожу в учебе новые интересные моменты.
3R It happens more and more often that I talk about my studies in a negative way Все чаще и чаще я говорю о своей учебе в негативном ключе
6R Lately, I tend to think less about my academic tasks В последнее время я все меньше думаю о своих
and do them almost mechanically академических задачах и делаю их почти механически
7 I find my studies to be a positive challenge * Я считаю свою учебу позитивным вызовом
9R Over time, one can become disconnected from this Со временем можно отказаться от такого типа обучения
type of study
11R Sometimes I feel sickened by my studies Иногда я испытываю отвращения от учебы
13 This is the only field of study that I can imagine myself doing *Это единственная сфера, в которой я себя представляю
15 I feel more and more engaged in my studies *Я все больше и больше вовлекаюсь в учебу
Exhaustion Истощенность
2R There are days when I feel tired before I arrive in Бывают дни, когда я чувствую усталость прежде чем я
class or start studying прихожу на занятия или начинаю учиться
Variance n (%) Non-burnout Disengaged Exhausted Burnout X2, p
Gender Female 522 (75) 368 (70.5) 65 (12.5) 47 (9.0) 42 (8.0) 2.29, p=0.130
Male 174 (25) 112 (64.4) 37 (21.3) 6 (3.4) 19 (10.9)
Academic year 1 year 206 (29.6) 171 (83.1) 13 (6.3) 11 (5.3) 11 (5.3) 40.4, p<0.001
2 year 129 (18.5) 75 (58.1) 17 (13.2) 20 (15.5) 17 (13.2)
3 year 102 (14.7) 62 (60.8) 18 (17.6) 12 (11.8) 10 (9.8)
4 year 52 (7.5) 37 (71.2) 10 (19.2) 2 (3.8) 3 (5.8)
5 year 65 (9.3) 52 (80.0) 10 (15.4) 0 3 (4.6)
6 year 142 (20.4) 83 (58.5) 34 (23.9) 8 (5.6) 17 (12.0)
Total 696 480 (69.0) 102 (14.6) 53 (7.6) 61 (8.8)
Table 2 (continued).
Item Original OLBI-S Russian version of OLBI (R-OLBI-S)
Strongly agree Agree Disagree Strongly disagree Полностью согласен Согласен Не согласен Полностью не согласен
1 2 3 4 1 2 3 4
Exhaustion Истощенность
4R After a class or after studying, I tend to need more time than in the past in order to relax and feel better После занятий или после учебы мне требуется больше времени, чем в прошлом, чтобы расслабиться и почувствовать себя лучше
5 I can tolerate the pressure of my studies very well *Я хорошо переношу давление в своей учебе
8R While studying, I often feel emotionally drained Во время учебы я часто чувствую эмоциональное истощение
10 After a class or after studying, I have enough energy for my leisure activities *После учебы у меня достаточно энергии для занятия досугом
12R After a class or after studying, I usually feel worn out and weary После учебы я обычно чувствую себя измученным(ой) и усталым(ой)
14 I can usually manage my study-related workload well *Обычно я могу хорошо справляться с работой, связанной с учебой
16 When I study, I usually feel energized *Когда я учусь, я обычно чувствую себя энергичным(ой)
R, reversed; *Removed items for the proposed Russian version
The OLBI-S includes 16 items defined in 2 subscales: Exhaustion and Disengagement. Each subscale includes 4 positively and 4 negatively worded items that are scored on a 4-point Likert scale from 1 "strongly agree" to 4 "strongly disagree". The average was calculated for each subscale, which was divided into quartiles and grouped into "low", "average", and "high" scores. Burnout categories were grouped according to Peterson et al. (2008) [13]. The CBI-S consists of 25 items that represent four dimensions: Personal Burnout (PB) - 6 items, Studies-related Burnout (SRB), Colleague-related Burnout (CRB), and Teacher-related Burnout (TRB).
Data analysis
Items' distributions were evaluated by the frequency analysis with skewness and kurtosis calculation. Construct validity was established by the confirmatory factor analysis (CFA) technique.
Bartlett's test of sphericity, Kaiser-Meyer-Olkin (KMO) measure of sampling adequacy were evaluated.
The CFA is used to assess the overall goodness of fit: X2/df, the Root Mean Square of Error Approximation RMSEA (< 0.08); the Comparative Fit Index CFI (> 0.9) and Tucker-Lewis Index TLI (> 0.9).
The convergent validity evidence was analyzed using the average variance extracted (AVE) and composite reliability (CR), which was estimated.
The constructs' convergent validity evidence was assumed for a value of AVE > 0.5, and CR > 0.70.
The factors' discriminant validity was assessed by comparing the AVE by each factor with the squared Pearson correlation between factors (AVEx/y > r2xy).
Reliability analysis was estimated using Cronbach's alpha (a).
Statistical analysis
Data analysis was performed by Microsoft Excel 2007, SPSS version 20.0, and Jamovi version 1.2.17. A statistically significant difference was accepted at a p-value of less than 5%. Frequencies and percentages were calculated for the categorical variables. A chi-squared test was used to assess the differences between these variables. Continuous numerical data were summarized as Mean (M) and Standard Deviation (SD).
Ethics statement
The study was approved by the Local Ethics Committee of the NpJSC "Astana medical university (extract from protocol No. 3, held on September 20, 2018).
Results
Table 3 gives descriptive statistics for items in R-OLBI-S. None of the items showed skewness and kurtosis absolute values indicative of severe violations of normality preventing further use in the factorial analysis.
Two-factor CFA of the R-OLBI-S indicated of poor fit (X2/df = 12.4, CFI = 0.685, TLI = 0.632, RMSEA = 0.128). Positively worded items of both Exhaustion and Disengagement subscales (items #1, 5, 7, 10, 13, 14, 15, and 16) shoed a low loading, and thus, this items was deleted.
The reduced model of 8 items R-OLBI-S showed better goodness-of-fit indices of two-factor structure (Figure 1; X2/df = 2.38, p < 0.001, CFI = 0.986, TLI = 0.979, SRMR = 0.023, RMSEA = 0.045, RMSEA 95% CI 0.0279 - 0.0614) compare to one-factor structure (x2/df = 8.20, p < 0.001, CFI = 0.923, TLI = 0.892, SRMR = 0.047, RMSEA = 0.102).
The Barlett's sphericity test result was significant (p < 0.001), and the KMO measure of sampling adequacy exceeded 0.886.
Table 3.
R-OLBI-S items: descriptive statistics.
R-OLBI-S items M SD SEM Min Max Mode CV Sk Ku
1* 2.26 0.83 0.03 1 4 2 0.37 0.54 -0.11
3R 2.30 0.80 0.03 1 4 2 0.35 0.24 -0.36
6R 2.45 0.77 0.03 1 4 3 0.31 -0.08 -0.41
7* 2.10 0.85 0.03 1 4 2 0.40 0.63 -0.03
9R 2.44 0.86 0.03 1 4 2 0.35 0.00 -0.67
11R 2.53 0.90 0.03 1 4 3 0.35 -0.10 -0.74
13* 2.42 0.96 0.03 1 4 3 0.40 -0.04 -0.98
15* 2.36 0.77 0.03 1 4 2 0.33 0.28 -0.25
2R 2.90 0.78 0.03 1 4 3 0.27 -0.67 0.42
4R 2.86 0.81 0.03 1 4 3 0.28 -0.35 -0.34
5* 2.49 0.75 0.03 1 4 2 0.30 0.26 -0.32
8R 2.60 0.80 0.03 1 4 3 0.31 -0.13 -0.44
10* 2.81 0.75 0.03 1 4 3 0.27 -0.28 -0.16
12R 2.83 0.78 0.03 1 4 3 0.28 -0.41 -0.07
14* 2.23 0.71 0.03 1 4 2 0.32 0.56 0.46
16* 2.58 0.76 0.03 1 4 3 0.29 0.03 -0.38
R, reversed; *Removed items for the proposed Russian version
Figure 1. R-OLBI-S two-factor reduced version (8-item) structure fit. X2/df = 2.38, p < 0.001, CFI = 0.986, TLI = 0.979, SRMR = 0.023, RMSEA = 0.045.
Calculated AVE and CR suggested acceptable convergent validity evidence for the R-OLBI-SS (8 items), AVE = 0.50 and CR = 0.80 for Disengagement subscale, AVE = 0.57, CR = 0.84 for Exhaustion subscale. The discriminant validity evidence between the two R-OLBI-S factors suggested that the two factors are strongly related to each other since AVEdisengagement = 0.50 and AVEexhaustion = 0.57 were smaller than r2 = 0.60.
Reliability for R-OLBI-SS, as estimated by Cronbach's a, was greater than 0.70, Cronbach's a for Disengagement subscale was 0.762, for Exhaustion subscale - 0.798, for total scale - 0.858.
The measurement model showed high and moderate correlations between R-OLBI-S's Disengagement and Exhaustion and CBI-S's Personal, Studies-related, and Teachers-related burnout (Table 4). All correlations were significant at a level p < 0.01.
Table 4.
Squared Pearson Correlations (r2) between factors of R-OLBI-S and CBI-S.
r2
Inventory Factors
PB SRB CRB TRB Dis
Personal burnout (PB)
CBI-S Studies-related burnout (SRB) 0.805
Colleagues-related burnout (CRB) 0.250 0.304
Teachers-related burnout (TRB) 0.522 0.646 0.378
R-OLBI-S Disengagement (Dis) 0.543 0.610 0.234 0.527
Exhaustion (Ex) 0.665 0.675 0.244 0.461 0.604
The data collection was divided into percentiles of 25, 50, and 75. The returned thresholds for both Disengagement and Exhaustion subscales and burnout categories are presented in Table 5. The prevalence of
R-OLBI-S Score Severity and Burnout Groups.
Discussion
In the presented study we adapted the student version of the Oldenburg Burnout Inventory (OLBI) to the Russian language and analyzed its internal structure in a sample of medical students of AMU (Kazakhstan).
The study provides that psychometric properties of the two-factor structured R-OLBI-S have convergent validity evidence and good goodness-of-fit indices. CFA showed low factorial weight for positively worded items (items #1, 5, 7, 10, 13, 14, 15, and 16), and these items were deleted. Problems with items 5, 13, 15 also have being reported [10], for items 14 and 16 [17], 5, 17, and 13 [7]. Sedlar et al. (2015) reported that negative items were more reliable than positive items [18], for this reason, we decided to use a reduced negative two-factor model with four items from each of the exhaustion and disengagement subscales. Correlation between the two constructs of the R-OLBI-S (i.e., less than 0.85) suggests that two factors of the scale are measuring different attributes of burnout, which is also proved by discriminant validity assessment. The high correlation between the subscales of the R-OLBI-S and the CBI-S indicates the specificity of the instrument for determining burnout syndrome. The internal consistencies of the two subscales of R-OLBI-S were acceptable, with Cronbach's a 0.762 and 0.798.
According to Sedlar et al. (2015), OLBI should be validated in the local setting first before it is used for
burnout among students was 31%, results depending on gender and the year of the study presented in Table 1. There was no difference in the burnout prevalence between females and males.
Table 5.
research purposes [18]. Based on our validation results, the proposed final 8-item R-OLBI-S is adequate for future burnout research in the population of medical students in Kazakhstan.
According to Peterson et al. criteria for burnout, the prevalence of burnout group was 8.8%, 14.6% of students were disengaged and 7.6% - exhausted. In total, the prevalence of burnout among medical students was 31%. Previous research used CBI-S, concluded that the prevalence of burnout was 28%, which was decreased after transmission to online learning format during the COVID-19 pandemic [1].
Conclusion
The adapted and validated Russian version of OLBI-S (R-OLBI-S) is a reliable tool for diagnosing burnout syndrome in students. This version can be used to assess the psychological status of College and University students of various profiles.
Authors' Contributions: All authors were equally involved in the research and writing of this article.
Conflict of Interest: The authors declare that they have no conflict of interest.
Funding: There is no financial support and sponsorship.
Publication Information: The results of this study have not been previously published in other journals and are not pending review by other publishers.
High (top quartile) Disengagement Scores > 2,75 Exhaustion Scores > 3.25
Average 2-2.75 2.5-3.25
Low (bottom quartile) < 2 < 2.5
Burnout Group High High
Exhausted Group Low or Average High
Disengaged Group High Low or Average
Non-Burnout Group Low or Average Low or Average
References:
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Corresponding author:
Bolatov Aidos Kanatovich - MD, NJSC «Astana Medical University», Nur-Sultan, Republic of Kazakhstan. Postal code: Republic of Kazakhstan, Z10K9D9, Nur-Sultan, Beybitshilik str., 49 a. E-mail: bolatovaidos@gmail.com Mobile phone: +7-777-600-00-96
