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Development and Validation of the Healthcare Worker Culture of Support Scale: Preliminary Evidence of Validity and Reliability

Albathi, M.; Gross, A. W.; Weston, C. M.; Connors, C.; Malik, M.; Wu, A. W.

2026-02-15 health systems and quality improvement
10.64898/2026.02.12.26346214 medRxiv
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ObjectiveTo develop and conduct preliminary testing of the reliability and validity of the Healthcare Worker (HCW) Culture of Support Scale (COS), intended to assess health worker perceptions of institutional support resources and organizational culture related to their well-being. MethodsA cross-sectional survey was conducted with 533 HCWs from ambulatory clinic and rural hospital settings. The survey included validated measures and newly developed items. Exploratory and confirmatory factor analyses (EFA/CFA) were employed to determine the factor structure. Internal consistency and construct validity were assessed using Cronbachs and correlation with mental health outcomes. ResultsThe COS demonstrated a robust three-factor structure: 1) Organizational Support ( = 0.83), 2) Access to Peer Support ( = 0.92), and 3) Availability of Support ( = 0.97), accounting for 84.9% of variance. Cronbachs alpha for the overall scale was 0.94. CFA confirmed excellent model fit (RMSEA =.049, CFI =.992). Higher COS scores correlated with lower burnout (r = -.47, p <.001) and anxiety (r = -.35, p <.001), and greater resilience (r =.30, p <.001). ConclusionPreliminary evidence suggests that the COS is a reliable and valid measure of HCWs perceptions of organizational support for worker well-being. This scale and the three subscales can provide healthcare institutions with a way to evaluate organizational initiatives to enhance worker well-being and workforce resilience. Further testing is recommended in diverse settings.

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