Received: 9 April 2020
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Revised: 2 July 2020
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Accepted: 13 July 2020
DOI: 10.1002/1348-9585.12157
ORIGINAL ARTICLE
Reliability and validity of the Vietnamese version of the 9-item
Utrecht Work Engagement Scale
Thuy Thi Thu Tran MSc1
| Kazuhiro Watanabe PhD2
| Kotaro Imamura PhD2 |
Huong Thanh Nguyen PhD3
| Natsu Sasaki MD2 | Kazuto Kuribayashi MHSc4 |
Asuka Sakuraya PhD5 | Nga Thi Nguyen MPH3 | Thu Minh Bui MNSc6 |
Quynh Thuy Nguyen PhD1 | Tien Quang Truong PhD3 | Giang Thi Huong Nguyen MNSc6
Harry Minas RANZCP7
| Akizumi Tsustumi MD8
| Akihito Shimazu PhD9
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2
Norito Kawakami MD
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1
Department of Occupational Health and
Safety, Faculty of Environmental and
Occupational Health, Hanoi University of
Public Health, Hanoi, Vietnam
2
Department of Mental Health, Graduate
School of Medicine, The University of
Tokyo, Tokyo, Japan
3
Faculty of Social Sciences – Behavior
and Health Education, Hanoi University of
Public Health, Hanoi, Vietnam
4
Department of Psychiatric Nursing,
Graduate School of Medicine, The
University of Tokyo, Tokyo, Japan
5
Department of Public Health, Tokyo
Women's Medical University, Tokyo, Japan
6
Nursing Office, Bach Mai Hospital, Hanoi,
Vietnam
7
Melbourne School of Population
and Global Health, The University of
Melbourne, Melbourne, Vic., Australia
8
Department of Public Health, Kitasato
University School of Medicine, Sagamihara,
Japan
9
Faculty of Policy Management, Keio
University, Fujisawa, Japan
Correspondence
Norito Kawakami, Department of Mental
Health, Graduate School of Medicine,
The University of Tokyo, 7-3-1, Hongo,
Bunkyo-ku, Tokyo, 113-0033, Japan.
Email: nkawakami@m.u-tokyo.ac.jp
Abstract
Objectives: The present study investigated the reliability and validity of a newly developed Vietnamese version of the 9-item Utrecht Work Engagement Scale (UWES9-V) in a sample of hospital nurses in Hanoi, Vietnam.
Methods: The UWES-9 was translated into Vietnamese following a standard procedure. A survey was conducted of 949 registered nurses in a large tertiary general hospital in Hanoi, Vietnam, in 2018, using a self-administered questionnaire including
the Vietnamese UWES-9, other scales measuring health status, work performance,
job demand, job control, and workplace social support, and questions pertaining
to demographic variables. Cronbach’s alpha and interclass correlation coefficients
(ICC) were calculated to assess reliability. Explanatory and confirmatory factor
analyses were conducted to assess factorial validity. Convergent validity was tested
based on associations between the UWES-9-V and subscales and other scales.
Results: The Cronbach’s alpha coefficients of the UWES-9-V and the Vigor,
Absorption, and Dedication subscales were 0.93, 0.86, 0.77, and 0.90, respectively.
ICC of the UWES-9-V in a subsample after 3 months was 0.48. Confirmatory factor
analyses indicated an acceptable fit of both one-factor and three-factor structures,
with the three-factor model having the better fit. The UWES-9-V and its subscales
correlated with depression, anxiety and stress, health-related quality of life and health
condition, job performance, and psychosocial work environment.
Conclusions: The study findings suggest that the UWES-9-V is a reliable and valid
instrument to measure work engagement among hospital nurses in Vietnam, a lowand middle-income country. Future studies should confirm the validity and reliability
of the UWES-9-V among various occupations.
This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium,
provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
© 2020 The Authors. Journal of Occupational Health published by John Wiley & Sons Australia, Ltd on behalf of The Japan Society for Occupational Health
J Occup Health. 2020;62:e12157.
https://doi.org/10.1002/1348-9585.12157
wileyonlinelibrary.com/journal/joh2
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TRAN ET AL.
Funding information
This research was supported by AMED
under Grant Number JP17jk0110014.
The funder had no role in study design,
data collection, and analysis, decision to
publish, or preparation of the manuscript.
1
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KEYWORDS
low- and middle-income countries, nurses, psychometrics, reliability, Utrecht Work Engagement
Scale (UWES), validity
BACKGROU N D
Since the introduction of positive psychology into occupational health, work engagement (WE), i.e., a positive, fulfilling, work-related state of mind that is characterized by vigor,
dedication, and absorption, has received much attention, as
it appears to be a key factor in the promotion of health and
well-being and work performance among workers.1 In the
healthcare sector, nurses are an important workforce whose
performance determines the quality of medical service provided. Higher levels of WE among nurses are associated with
better patient outcomes,2 and negatively related to burnout
and psychological distress among nurses.3,4 Even in low- and
middle-income countries (LMICs), a shortage of healthcare
professionals,5 and increased demands for care from the
aging population, nurses face increasing stress and burnout
at work. This is particularly the case in South-East Asia5
including Vietnam.6 Research is needed to investigate the
determinants and consequences of WE as well as an intervention to promote WE among nurses in LMICs in SouthEast Asia. However, only a few studies were reported on WE
among nurses in these countries.7,8 To promote research on
WE among nurses in these LMICs, it is essential to establish
a reliable and valid measure of WE among nurses in these
countries.
Worldwide, several methods to measure WE are available in the literature.9 Among them, the Utrecht Work
Engagement scale (UWES)10 is the most widely used tool to
measure WE among nurses9 as well as the general working
population.11 Between the original 17-item UWES (UWES17) and the short version of the 9-item UWES (UWES-9),
the latter scale is psychometrically better11 and more stable in
measuring WE over time.12 The UWES-9 is widely used in
studies of nurses in hospital settings since it requires less time
and effort to complete9 and has good reliability.3,13 However,
most validation studies of the UWES-9 among nurses (or
multiple occupations including nurses) have been conducted
in high-income countries10,12-14 or in Europe.12,13,15 No validation study of the UWES-9 among nurses in the South-East
Asia region is available in the literature. Among LMICs in the
Central and South Asia, the validity of the UWES-9 was only
assessed in two countries, Nepal3 and China.4 In Vietnam,
only one study used the UWES-9 to study WE among hospital nurses.8 However, the translation did not follow a standard
procedure, and the reliability and validity of that Vietnamese
UWES were not reported. The validity of the UWES-9 may
be different across countries and cultures. For instance, the
construct validity of the UWES-9 is inconsistent across
published studies among nurses, with some reporting a onefactor model14 but others reporting a three-factor model.3,4
A formal Vietnamese version of the UWES-9 (UWES-9-V)
needs to be developed and its validity tested among nurses in
Vietnam in order to apply the concept of WE among nurses in
Vietnam, and to compare the validity of the UWES-9-V with
that of versions of other countries.
This study aimed to examine the reliability and validity of
the UWES-9-V among hospital nurses in Vietnam. Reliability
was assessed via internal consistency (Cronbach’s alpha coefficient) and test-retest reliability (Intraclass correlation coefficient-ICC). Factorial validity and construct validity of the
UWES-9-V were explored with confirmation factor analysis
(CFA), explanatory factor analysis (EFA) and correlations
with other scales.
2
2.1
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M ETHODS
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Participants and procedure
This study used data from a three-armed randomized controlled trial study that recruited full-time registered nurses
in one large tertiary general hospital in Hanoi, Vietnam.
Sampling and criteria to recruit participants were described
by Imamura et al16 A total of 1,258 eligible nurses were
invited to participate in the study. A total of 949 of them
returned the structured self-administrated questionnaires
(75.44% response rate). Participants were equally and randomly assigned to two intervention groups and one control
group based on their depression score. The original intervention study included a baseline survey (August-September
2018), a 3-month follow-up (January 2019), and a 7-month
follow-up (April 2019).
A recent Risk of Bias checklist based on consensus-based standards for the selection of health measurement instruments (COSMIN) requires the minimum
sample size for factor analysis to be 100.17 In addition,
the literature review shows that WE has a low correlation
with other constructs (IrI ranged from 0.11 to 0.41),3,18 and
the minimum sample size is 853 when effect size = 0.1,
alpha = 0.05, and 1-beta = 0.90, using G*Power version
3.1.9.4 (minimum sample size for Pearson’s r, Exact test,
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TRAN ET AL.
Correlation: Bivariate normal model. A priori: Computed
required sample size, given alpha, power, and effect size).
Therefore, data from the baseline survey (949 nurses) had
an adequate sample size for the calculation of the UWES9-V’s Cronbach’s alpha, CFA, EFA, correlations with other
scales, and distribution of WE scores.
Data from baseline and 3-month follow-up surveys of a
subsample (control group, 286 participants) were used to examine test-retest reliability with a 3-month interval.
and lively”; the phrase of “get carried away when working”
(item #9) was replaced by a Vietnamese phrase meaning
“I intensely concentrated at work so that I forgot other
things”. These amended items were again back-translated
and approved by Prof. Schaufeli.
2.3 | Other scales for testing the construct
validity of the UWES-9-V
2.3.1
2.2
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Depression, anxiety and stress
Measures
2.2.1 | The Vietnamese version of the 9-item
Utrecht Work Engagement Scale(UWES-9-V)
An official Vietnamese version of the UWES-9 was not
available when we started this study. We independently
translated the original English version of the UWES-910
into Vietnamese, with the permission of Prof. Wilmar
Schaufeli. The UWES-9 has a 7-point rating scale
(0 = never; 6 = everyday) and consists of three questions
to measure each of WE’s three dimensions, namely, Vigor
(items 1, 2, 5), Dedication (items 3, 4, 7), and Absorption
(items 6, 8, 9). Subscale scores consist of the mean for each
set of three questions. Hence, the three subscale scores
range between 0 and 6. Similarly, the overall scale score
consists of the mean of the nine items.
The development of the UWES-9-V followed the
UWES’s original manual10 and the standard procedure of
translation and cultural adaptation of patient reported health
outcomes.19 First, the forward translation of the scale from
English to Vietnamese (draft UWES-9-V) was completed
by one translator proficient in both languages with knowledge about the topic (April 2018). Face validity of the draft
UWES-9-V was assessed among 30 nurses in the target
hospital to test their understanding of the language translation. It also was sent to a psychiatrist for a professional assessment of the wording. Second, the draft UWES-9-V was
piloted among 150 nurses (June, 2018). All comments and
suggestions were carefully considered in the revision of the
UWES-9-V. Third, the revised UWES-9-V was translated
into English by a different proficient translator who did not
participate in this project. The backward translation of the
revised UWES-9-V was sent to its original author, Prof.
Schaufeli, to compare with the original scale, followed by
iterative processes. He raised questions on the translation
of two items (item #2 and #9). Alternative wordings and
phrases were proposed for these items based on an extensive
discussion with the research team and senior nurses in the
target hospital: the phrase of “strong and vigorous” (item
#2) was replaced by a Vietnamese phrase meaning ““physically and mentally healthy, good at verbal communication,
The 21-item version of the Depression, Anxiety and Stress
Scale (DASS-21) measures symptoms of depression, anxiety, and stress in the community20 with self-ratings on 21
statements such as “I was aware of dryness of my mouth.”
Each item is rated on a scale ranging from 0 (did not apply
to me at all) to 3 (applied to me very much, or most of the
time). The DASS-21 comprises three subscales with seven
items for each dimension. The sum of the seven items’
scores is the total score for each subscale, and thus ranges
from 0 to 21.20 The Vietnamese DASS-21 (DASS-21-V)
was reported to be reliable in measuring mental problems
among hospital nurses in Vietnam.6 In this study, the
Cronbach’s alpha coefficients for the DASS-21-V and the
Depression, Anxiety, and Stress subscales were 0.92, 0.82,
0.77, and 0.83, respectively.
2.3.2
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Health-related quality of life
The 5-level EQ-5D (EQ-5D-5L) is a widely used measurement of Health-related quality of life (HRQOL). The EQ5D-5L contains five items covering mobility, self-care,
usual activities, pain/discomfort, and anxiety/ depression,
each of which is rated from level 1 (no problems) to level
5 (unable to). The Vietnamese version was developed and
tested for its reliability and validity.21 We used the Standard
Value Set for Vietnam to calculate HRQOL scores for
participants.22
2.3.3
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Psychosocial work environment
The Job Content Questionnaire (JCQ) is used to measure
the psychosocial work environment.23 The JCQ includes
four subscales: a psychological demand scale (five items), a
decision latitude (job control) scale (nine items), a supervisor support scale (four items), and a coworker support scale
(four items), with a 4-point response options ranging from 1
(strongly disagree) to 4 (strongly agree). The reliability and
validity of the Vietnamese version of JCQ among nurses in
this study were acceptable.24
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2.3.4
Self-rated health
Participants were asked to rate their health status on a 100point visual analog scale, in which 0 indicated the worst
health and 100 meant the best health condition. This scale is
a part of the EQ-5D-5L,21 but not used in the computation of
the HRQOL score.
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2.3.5
Global job performance
Global job performance was measured with the single item
“Using a 0-to-10 scale, how would you rate your overall job
performance on the days you worked during the past 4 weeks
(28 days)?” It is a part of the World Health Organization—
Work Health Performance Questionnaire (WHO HPQ), in
which 0 indicates the “worst possible work performance” a
person could have on this job and 10 means the “top work
performance” on this job.25 The final global job performance
rating is the multiplication of this item score by 10, so this
scale’s score ranges from 0 to 100. The Vietnamese version
of the WHO HPQ is not validated yet.
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2.3.6
Demographic variables
The following demographic variables were included in the
analysis. Gender was categorized as male or female. Age in
years was calculated based on the respondent’s birth year.
Three age groups were used, namely, under 30 years old
(career start), 30-45 years old (transition to higher work
position), and above 45 years old (prime working life and
stable position at work). The labor contract was categorized
into four types: fixed-term contract for less than 1 year,
fixed-term contract for more than 1 year, no fixed-term contract, and permanent contract. The number of years working
as a nurse was divided into three groups (≤10, 11-20, and
≥21 years).
2.4
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Statistical analysis
Internal consistency reliability of the UWES-9-V and three
subscales was evaluated using Cronbach’s alpha coefficients.
The mean and standard deviation (SD) of item scores, itemtotal correlation, and Cronbach’s’ alpha coefficient when an
item was deleted for the UWES-9-V and each subscale were
calculated. A Cronbach’s alpha coefficient larger than 0.70
was acceptable.
Test-retest reliability of the UWES-9-V and subscales was
examined using intraclass correlation coefficients (ICC), a
two-way random model, and type absolute agreement. The
95% confidence interval (CI) of ICC values less than 0.50,
between 0.50 and 0.75, between 0.75 and 0.90, and greater
than 0.90 were indicative of poor, moderate, good, and excellent reliability, respectively.26 A paired t-test was conducted
to compare the mean scores for the UWES-V and its subscales between two surveys.
For factorial validity, EFA was first conducted with maximum likelihood extraction. The number of factors was determined based on examination of the scree plot. Then, CFA
(maximum likelihood estimation) was applied to examine the
fit of one-factor and three-factor structure models. Several
fit indices were used to determine the model fit, namely, the
comparative fit index (CFI), the non-normed fit index (NNFI,
also known as Tucker-Lewis index—TLV) greater than 0.95,
the root-mean-square error of approximation (RMSEA) and
90% CI less than 0.06, standardized root-mean-square residual (SRMR) less than 0.08, the lower Akaike information criterion (AIC); chi-squared test, degrees of freedom (df), and
significance level (P) were included.27 Modification indices
were examined if both structures did not have a good fit due
to error covariance, and adjustments were made as necessary by freeing error covariance as reported by the previous
studies.12
For convergent validity, we selected the following hypotheses to assess the associations of the UWES-9-V
and subscales and other relevant scales. Based on the Job
Demands-Resources (JD-R) model,28 job resources (e.g.,
job control and social support at work from supervisors and
coworkers) enhance WE.29 The JD-R model did not address
the association between job demand and WE; however, studies reported a weak positive association between these two
constructs.18 Regarding health outcomes, UWES-9 scores inversely and weakly correlated with depression, anxiety,30 and
psychological distress,3 but was moderately and positively
associated with health-related quality of life31 and overall
health.3 UWES-9 scores also moderately and positively correlated with job performance.3 In this study, these associations were assessed using Pearson’s correlation (r).
Distribution of the UWES-9-V and its subscales’ scores
were examined based on gender, age, type of labor contract,
and work experience using t-tests (for two groups) or oneway analysis of variance (ANOVA) and post hoc tests with
Bonferroni correction (for more than two groups) at the significant level of P less than .05.
All analyses were conducted using the IBM Statistical
Package for Social Sciences (SPSS) version 20 except for the
confirmatory factor analysis, which was conducted using IBM
SPSS analysis of moment structures (AMOS) version 20.
3
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RESULTS
Baseline data for 942 nurses were analyzed (final response
rate 74.88%; 7 cases were removed because of missing data).
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TRAN ET AL.
T A B L E 1 Internal consistency
reliability as Cronbach’s alpha coefficients
of UWES-9-V and subscales (N = 942)
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Items
Mean
SD
Item-total
correlation
Alpha coefficient when
deleting an item
Item 1 bursting with
energy (V1)
4.30
1.54
.72
.92
Item 2 strong and
vigorous (V2)
4.47
1.44
.78
.92
Item 5 in the morning,
feel like going to work
(V3)
4.04
1.64
.79
.92
Item 3 enthusiastic about
job (D1)
4.48
1.47
.85
.92
Item 4 job inspires me
(D2)
4.25
1.48
.84
.92
Item 7 proud of the work
(D3)
4.75
1.49
.77
.92
Item 8 immersed in
work (A1)
4.31
1.46
.72
.92
Item 6 happy when
working intensely (A2)
4.32
1.55
.82
.92
Item 9 get carried away
when working (A3)
3.64
1.75
.45
.94
Vigor (UWES-V)
4.09
1.32
.86
Dedication (UWES-D)
4.49
1.35
.90
Absorption (UWES-A)
4.27
1.37
.77
UWES-9-V
4.29
1.23
.93
Abbreviations: SD: standard deviation; UWES-9-V: Vietnamese version of the 9-item Utrecht Work
Engagement Scale; UWES-A: absorption subscale; UWES-D: dedication subscale; UWES-V: vigor subscale
of UWES.
84.82% of respondents were female nurses with a mean
age of 34.08 (SD = 6.79) and an average number of working years as a nurse of 10.33 (SD = 6.97). In the subsample
of 286 nurses used to examine test-retest reliability, 84.27%
of respondents were female nurses with mean age 33.81
(SD = 6.52) and an average number of working years as a
nurse of 9.95 (SD = 6.61).
3.1
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Scale reliability
Table 1 presented information on the internal consistency
of the UWES-9-V and the three subscales. The means of all
items were identical, excepting item 9 (UWESA3 “I get carried away when working”), which had a lower mean score.
This item also had a lower item-total correlation (0.45) compared with those of the other eight items (0.72–0.85). The
Cronbach’s alpha coefficients for the UWES-9-V, Vigor,
Absorption, and Dedication subscales were 0.93; 0.86, 0.77,
and 0.90, respectively. Most items substantially contributed
to the whole scale’s Cronbach’s alpha coefficient, excepting
item 9. The UWES-9-V’s Cronbach’s alpha increased 0.01 if
item 9 was deleted.
Table 2 showed that the Vigor mean score significantly
increased between the baseline and 3-month follow-up surveys (P = .04). There was no significant difference in mean
scores for the UWES-9-V and the dedication, absorption
subscales (P > .05). Test-retest reliability or stability of
the UWES-9-V and three subscales was measured after 3
months in a subsample of 286 nurses (control group of the
original intervention study). ICCs were calculated using
two-way random effect models with absolute agreement.
Stability of the UWES-9-V (95% CI) was 0.48 (0.35–0.59).
The lowest value belonged to the Vigor subscale (0.35,
95% CI = 0.19–0.49).
3.2
3.2.1
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Scale validity
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Factorial validity
With the inconclusive agreement on factor validity of the
UWES-9 and limited application of the UWES in LMICs,
we examined both one-factor and three-factor models to see
which models were appropriate within the Vietnamese context. In EFA, initial eigenvalues (% of variance explained)
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TABLE 2
TRAN ET AL.
Test-retest reliability as IntraClass correlation coefficients of UWES-9-V and subscales in the 3-month interval (N = 286)
Baseline
Items
Vigor
Dedication
Mean
4.27
4.62
3 months
SD
1.33
1.23
Mean
4.47
4.70
Paired t-test
SD
1.25
1.25
t
Intraclass
correlation
P
−2.09
.04
−0.97
.33
95% CI
Lower
Upper
.35
**
0.19
0.49
.51
**
0.39
0.61
**
0.37
0.60
0.35
0.59
Absorption
4.14
1.20
4.24
1.27
−1.19
.24
.50
UWES-9-V
4.34
1.11
4.47
1.14
−1.64
.10
.48**
Abbreviations: CI, confidence interval, p, significant level; SD: standard deviation; t: t-test value.
**P < .01
TABLE 3
Model
Fit indices of one-factor and three-factor models of the UWES-9-V: Confirmation factor analysis (N = 942)
NNFI/
TLV
CFI
SRMR
RMSEA
RMSEA 90%
CI
AIC
CMIN
df
P
M1—1 factor
0.91
0.92
0.13
0.15
0.14-0.16
636.04
600.04
27
<.01
M2—3 factor
0.93
0.93
0.12
0.15
0.13-0.16
541.27
499.27
24
<.01
M3—1 factor
0.97
0.97
0.06
0.09
0.08-0.10
262.41
222.41
25
<.01
M4—3 factor
0.97
0.98
0.05
0.09
0.08- 0.10
227.53
181.53
22
<.01
Abbreviations: AIC, Akaike information criterion; CFI, Comparative fit index, CI, Confidence interval; CMIN, Chi-square mean; df, degree of freedom; NNFI/ TLV,
Non-normed fit index/Tucker-Lewis index; P: significant level; RMSEA, Root mean square error of approximation; SRMR, Standardized Root mean square residual.
for factor 1 to 9 were 5.95 (66.08), 0.93 (10.35), 0.57 (6.34),
0.35 (3.88), 0.31 (3.46), 0.29 (3.31), 0.23 (2.57), 0.21 (2.33),
and 0.15 (1.68), respectively, yielding one factor. Preliminary
CFA with robust maximum likelihood estimation (Models 1
and 2 in Table 3) showed that both the one- and three-factor
models had a very poor fit with the current data. All fit indices were out of the acceptable range for both the one-factor
model, where 9 items loaded on the uniform WE, and the
three-factor model in which each item loaded on its theoretical dimensions (Vigor, Absorption, or Dedication) (NNFI/
TLV/CFI less than 0.95, SRMR and RMSEA exceeded 0.08
and 0.06, respectively). The analysis of modification indices
showed that both models had substantial error covariance
between two pairs of items: UWESV1 (“Bursting with energy”) and UWESV2 (“Strong and vigorous”): UWESA1
(“immersed in work”) and UWESA3 (“Get carried away
when working”) (error covariance ranged from 0.40 to 0.69
in Model 1 and from 0.29 to 0.60 in Model 2). After adjustment was made for the error covariance, the modified
one-factor model (Model 3) and three-factor model (Model
4) obtained good fit indices, although RMSEA was slightly
higher than the threshold 0.06 (Table 3).
Between the two modified models, the three-factor model
showed a significantly better fit with the data (higher CFI,
lower SRMR, smaller AIC, Δχ2 = 100.87, Δdf = 3, P < .01).
All factor loadings exceeded 0.70 in both modified models,
excluding item 9 (UWESA3 “Get carried away when working”) with loadings of 0.43 in Model 3 and 0.44 in Model
4. High correlations (>.90) between pairs of three latent
dimensions (vigor, absorption, and dedication) were presented in Figure 1.
3.2.2
|
Convergent validity
Table 4 showed that UWES-9-V scores correlated negatively
and weakly with scores for depression, anxiety, and stress
(r = −.33 to −.22). It weakly and positively correlated with
HRQOL, self-rated health, and work performance (r = .26,
.28, and .21, respectively). Job demand weakly and negatively correlated with the UWES-9-V score (r = −.16), while
the other three aspects of the psychosocial work environment, namely, job control, supervisor support, and coworker
support positively correlated with WE (r = .24, .22, and .20,
respectively).
3.3 | Distribution of WE among
different groups
Table 5 presented comparisons of WE scores among demographic groups using t-tests or one-way ANOVAs with post
hoc tests. A significant difference in WE was observed between males and females and among nurses with different
labor contract types. Male nurses had considerably higher
WE than their female coworkers, with their mean scores for
the three dimensions of WE all being higher than those for
the female nurses (P < .05). Nurses with labor contracts of
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TRAN ET AL.
F I G U R E 1 Modified path diagram of the UWES-9-V with
standardized coefficients from the confirmatory factor analysis
(N = 942). U: error, UWESV 1, 2, 3: items 1, 2, 3 of Vigor subscale
or items 1, 2, 5 of the UWES-9-V; UWESD 1, 2, 3: items 1, 2, 3, of
Dedication subscale or items 3, 4, 7 of the UWES-9-V; UWESA 1, 2,
3: items 1, 2, 3 of Absorption subscale or items 8, 6, 9 of the UWES9-V.
less than 1 year expressed higher WE than those who signed
no fixed-term contract with the hospital (P < .05).
4
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D IS C U SS ION
The Vietnamese version of the UWES-9 showed an acceptable level of reliability. The one- and three-factor structures of
the UWES-9-V obtained acceptable fit, with the three-factor
TABLE 4
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model having a better fit. Convergent validity was supported
with expected correlations between the UWES-9-V and other
scales. The study findings suggest that the Vietnamese version of the UWES-9 is a reliable and valid instrument to
measure WE among hospital nurses in Vietnam.
The new UWES-9-V had excellent internal consistency
(Cronbach’s alpha coefficient 0.93), higher than that was
found in studies of nurses from Nepal (0.81),3 one of the
low-income countries. The UWES-9-V internal consistency
was also better than that of versions of several other Asian
countries, namely, Japan (0.92),14 Malaysia (0.90),7 and
China (0.88).4 Cronbach’s alpha coefficients for the three
subscales were acceptable but not as good as the uniform
UWES-V-9. However, item 9 (UWESA3) showed considerably lower item-total correlation compared with the other
items. This item also had low factor loading and noticeable
error covariance in CFAs. Nevertheless, we kept item 9 since
its presence had an insubstantial effect on scale reliability and
validity. One possible reason for the differential performance
of the item 9 could be that the Vietnamese wording that we
selected for this item had a less positive nuance compared to
that of other items and participants might rate this item differently from the other items. This item may measure a different construct, such as workaholism, rather than WE. Future
studies should further examine the validity and reliability of
item 9 in the UWES-9-V in different target groups. It is possible that both the contextually based translation and the direct
meaning translation of this item (although a direct meaning
translation might create confusion in the local language and
context) should be examined in the validation process.3
Among previous studies, test-retest reliability of the
UWES-9 varied, ranging from 0.66 (2-month interval)14
Associations between UWES-9-V and three subscales and other scales
Pearson’s correlation coefficienta
Whole sample
Variables (score range)
Nb
Mean
SD
UWES9-V
UWES-A
UWES-D
UWES-V
DASS depression (0-21)
927
3.00
2.90
−0.33
−0.20
−0.35
−0.35
DASS anxiety (0-21)
930
3.90
3.10
−0.22
−0.12
−0.26
−0.23
DASS stress (0-21)
929
5.60
3.60
−0.27
−0.16
−0.29
−0.28
HRQOL (0-1)
942
0.90
0.10
0.26
0.16
0.27
0.29
Self-rated health (0-100)
940
85.60
11.60
0.28
0.21
0.25
0.31
Global job performance (0-100)
942
84.40
11.20
0.21
0.19
0.18
0.20
JCQ job demand (12-48)
942
31.50
4.40
−0.16
−0.11
−0.18
−0.14
JCQ job control (24-96)
927
81.10
6.40
0.24
0.20
0.22
0.23
JCQ supervisor support (4-16)
937
12.00
1.90
0.22
0.17
0.21
0.22
JCQ coworker support (4-16)
940
12.20
1.50
0.20
0.16
0.19
0.21
Abbreviations: DASS, Depression, Anxiety and Stress scale; JCQ, Job Content Questionnaires; SD, standard deviation; UWES-9-V: Vietnamese version of the 9-item
Utrecht Work Engagement Scale; UWES-V: vigor subscale of UWES; UWES-D, dedication subscale; UWES-A, absorption subscale.
a
All correlations were significant at .01 level (one tailed).
b
The number of participants varied due to missing responses on each variable.
8 of 11
|
TABLE 5
TRAN ET AL.
Work engagement across demographic groups (N = 942)
Variables
Gender
Types of labor
contract
Age (years)
Years of working
Group
N
UWES-9-V
UWES-A
Mean
Mean
**
SD
*
UWES-D
SD
Mean
**
UWES-V
SD
Mean
*
SD
Male
143
4.56
1.16
4.35
1.27
4.81
1.26
4.51
1.31
Female
799
4.24
1.24
4.04
1.32
4.44
1.36
4.23
1.37
a ,*
a ,*
a ,*
≤1 year
221
4.49
1.07
4.27
1.13
4.73
1.18
4.46
1.22
>1 year
29
4.26
1.15
4.06
1.16
4.39
1.44
4.33
1.18
No fixed term
193
4.16
1.27
3.91
1.40
4.36
1.34
4.21
1.33
Permanent
499
4.24
1.28
4.08
1.36
4.45
1.41
4.20
1.44
≤30
420
4.32
1.20
4.07
1.29
4.54
1.29
4.36
1.30
31-45
479
4.24
1.27
4.10
1.35
4.44
1.41
4.18
1.42
≥46
43
4.45
1.12
4.22
1.22
4.68
1.26
4.46
1.26
≤10
545
4.34
1.17
4.10
1.28
4.56
1.26
4.34
1.29
11-20
300
4.20
1.30
4.06
1.37
4.39
1.43
4.15
1.47
≥21
97
4.27
1.33
4.11
1.39
4.44
1.52
4.27
1.45
Abbreviations: SD, standard deviation; UWES-9-V, Vietnamese version of the 9-item Utrecht Work Engagement Scale; UWES-V, vigor subscale of UWES;
UWES-D, dedication subscale; UWES-A, absorption subscale.
a
ANOVA with a post hoc test with Bonferroni correction. The mean scores of UWES, UWES-A, and UWES-D were significantly higher among participants with a
labor contract less than 1 year as to compare with those among nurses with no fixed-term labor contract (P < .05). Otherwise, no significant difference (P > .05).
*P < .05.
**P < .01
to 0.70 (1-year interval)10 and 0.91 (2-week interval).32
The 3-month test-retest reliability (ICCs) in our study was
moderate,26 but lower than that of these reports. It was particularly lower for the Vigor subscale score, which significantly improved during the 3-month follow-up (from 4.27
to 4.47, P = .04). The results might be attributable to potential contamination of information on stress management
in the present sample (the control group) from intervention groups who received smartphone-based cognitive-behavioral training programs.16 Other possible explanations
included a seasonal change in workload or other organizational changes in the target hospital. The stability and
repeatability of the UWES-9-V needs more confirmation
from future studies, with control of factors associated with
WE.
The findings for the EFA and CFA indicated that both
the one-factor and three-factor structures of the UWES-9-V
were acceptable (CFI/ NNFI > 0.95, SRMR < 0.08, RMSEA
close to 0.06). The three-factor model had a better fit for the
current data but very high correlations between three dimensions (r > .90) indicated that the UWES-9-V could be used
as a unitary construct to measure WE or applied separately
to differentiate Vigor, Absorption, and Dedication. The factorial validity of the UWES-9-V was similar to the Nepalese
UWES-9, which was validated among nurses in a LMIC country.3 Most available studies supporting either the one-factor
or three-factor structures were conducted among nurses in
countries that were not LMICs.4,10,12,14,15 Our findings contribute to the popularity and suitability of the UWES-9 with
the three-factor structure across diverse settings and occupations, including nurses in LMICs and Vietnam. However, the
one-factor UWES-9 requires more robust evidence on its validity and reliability in measuring WE among the healthcare
workforce in LMICs.
In our study, the UWES-9-V showed good convergent
validity. Scores for depression, anxiety, and stress all correlated weakly and negatively with the UWES-9-V and its
subscales’ scores, which was concordant with previous
findings of negative correlations between mental health
problems and WE.3,4,30 In previous studies, HRQOL and
self-rated health also correlated moderately with WE.3,31
Job control, supervisor support, and coworker support correlated weakly (r = .20-.24) in expected directions.7,18 The
negative correlation between job demand and WE in this
study was inconsistent with findings from previous studies among Japanese employees18 which reported low but
positive correlations between WE and workload and time
pressure. This could be attributable to cultural and occupational differences. High job demand is not regarded as motivation to work by Vietnamese nurses who have a high risk
of increased psychological stress because of high workload
and work pressure.6 In addition, the target participants in
this study were nurses in one hospital, while the Japanese
studies were conducted with a considerably broader sample
of the working population. Regarding performance, WE
positively related to work performance among Vietnamese
nurses. The work commitment of employees was associated with their performance and improvement of the
|
TRAN ET AL.
service they provided.3 The present study confirms an adequate level of convergent validity of the UWES-9-V and
subscales in measuring WE among hospital nurses.
The mean score of the UWES-9-V was lower than
those in other studies among Malaysian nurses,7 US emergency nurses,33 and Finnish nurses.34 It was considerably
higher than results for Japanese nurses/employees18,35 and
Chinese registered nurses.4 Lower WE scores in Japan have
been attributed to a culture-specific response tendency to
suppress positive emotions.36 This may be not the case in
Vietnam. When exploring WE among groups with different
demographic characteristics, WE significantly associated
with gender and type of labor contract. The considerably
higher WE in men compared with women in our study was
in line with that of other studies.10 Female nurses reported
lower scores than their male coworkers in all three WE dimensions as well as overall WE. In Vietnam, women are
expected to be responsible for household chores and family
care37 while men hold the leading role in supporting the
family. It is normal for men to rest and relax after work
when their wives continue cooking, cleaning, or caring for
other family members. In order to fulfill their traditional
family responsibilities and also do their job, female nurses
bear more workload and have comparably less leisure time
in comparison with their male coworkers. This comparative
lack of leisure time eventually affects both their physical
and mental health, resulting in lower WE.3,4 Hence, with a
majority of employed women in this study (84.82%), support for female nurses at work is necessary to keep them
engaged in hospital tasks.
Interestingly, nurses with short-term contracts were more
enthusiastic about their job than those with no fixed-term
contract. In Vietnam, having a contract without fixed-term
brings more advantages for employees such as resignation
with advance notice at any time for any reason without compensation related to breach of contract, and eligibility for
unemployment insurance.38 A contract without a fixed-term
is usually used to replace short-term contracts for workers
who have been working at the current workplace for over
3 years, but are still not eligible for a permanent contract
by the time of contract renewal. This result is considered
consistent with the decline in WE among nurses with more
years of work experience in this study. Our results contradict
prior research which reported a positive association between
WE and work experience, and more commitment among
permanent/ senior nurses in Nepal and Iran.3,32 Our findings might be attributable to the typical work environment
of Vietnamese tertiary hospitals. A cluster analysis reported
that in comparison with younger nurses, older nurses with
over 6 years of service experienced a combination of greater
job demand, lower social support at work, and a higher risk
of multiple mental disorders6 which adversely affected their
commitment to work. Our study emphasizes the importance
9 of 11
of addressing the determinants of WE in occupational research to accurately and comprehensively interpret the study
results.
The chief limitation of this study is the uniformity of participants, i.e., only nurses in one hospital, with an unequal
distribution of gender. Caution should be exercised in generalizing these findings to the general population or other occupations in Vietnam. Second, the self-report approach may
result in different understandings among study participants.
Future studies should validate the UWES-9-V with a broader
range of occupations. Third, one of the scales used to test the
construct validity of the UWES-9-V, the work performance
scale, has not been validated yet. Finally, we could not investigate other important properties of UWES-9-V such as
content validity, cross-cultural validity, criterion validity, and
responsiveness. However, the study clarifies the psychometric properties of the newly developed Vietnamese version of
the UWES-9, a useful tool to measure WE among hospital
nurses in Vietnam.
5
|
CONCLUSION
This study confirms that the Vietnamese version of the
UWES-9 has satisfactory psychometric properties and will be
a suitable tool to measure WE in Vietnam, especially among
nurses. This is also the first step to introducing the concept
of positive occupational psychology, i.e., WE, in Vietnam in
order to improve workers’ mental health.
ACKNOWLEDGMENTS
The authors acknowledge the support and contribution of
the Board of Directors and the Nursing Office in Bach Mai
hospital for the implementation of this study. We thank all
nurses who participated in and provided their information for
the study and highly appreciate the contribution of a research
team from Hanoi University of Public Health, an important
partner in making this study possible.
AUTHORS' CONTRIBUTIONS
KI, TTran, HN, KK, AS, TB, AN, QN, NN, GN, TTruong,
HM, NS, AT, and NK conceived and designed the survey.
TTran, HN, TB, AN, QN, NN, GN, and TTruong collected
data. TTran and NK analyzed data and wrote the article. HN,
AT, and AShimazu were major contributors to the study. KW,
NS, AS, and NN provided important comments for the final
manuscript. All authors read and approved the final manuscript.
ETHICS APPROVAL AND CONSENT TO
PARTICIPATE
The study protocol was reviewed and approved by the
Research Ethics Committee of Graduate School of
Medicine/Faculty of Medicine, The University of Tokyo
10 of 11
|
(no. 11991-(1)), and the Ethical Review Board for
Biomedical Research, Hanoi University of Public Health
(no 346/2018/YTCC-HD3) before implementation. All
participants signed the consent form before joining this
study.
DECLARATION OF INTERESTS
NK reports grants from Infocom Corp, Fujitsu Ltd, Fujitsu
Software Technologies, and TAK Ltd, personal fees from the
Occupational Health Foundation, Japan Dental Association,
Sekisui Chemicals, Junpukai Health Care Center, Osaka
Chamber of Commerce and Industry, outside the submitted
work.
DATA AVAILABILIT Y STATEMENT
The datasets used for this study are available from the corresponding author on reasonable request.
ORCID
Thuy Thi Thu Tran
https://orcid.org/0000-0002-2758-7695
Kazuhiro Watanabe
https://orcid.org/0000-0002-3342-6142
Huong Thanh Nguyen
https://orcid.org/0000-0002-9493-9590
Harry Minas
https://orcid.org/0000-0003-1719-7367
Akizumi Tsustumi
https://orcid.org/0000-0003-0966-4869
Akihito Shimazu
https://orcid.org/0000-0002-7172-0043
Norito Kawakami
https://orcid.org/0000-0003-1080-2720
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How to cite this article: Tran TTT, Watanabe K,
Imamura K, et al. Reliability and validity of the
Vietnamese Utrecht work engagement 9 items. J
Occup Health. 2020;62:e12157. https://doi.
org/10.1002/1348-9585.12157
Minerva Access is the Institutional Repository of The University of Melbourne
Author/s:
Thuy, TTT; Watanabe, K; Imamura, K; Huong, TN; Sasaki, N; Kuribayashi, K; Sakuraya, A;
Nga, TN; Thu, MB; Quynh, TN; Tien, QT; Giang, THN; Minas, H; Tsustumi, A; Shimazu, A;
Kawakami, N
Title:
Reliability and validity of the Vietnamese version of the 9-item Utrecht Work Engagement
Scale
Date:
2020-01-01
Citation:
Thuy, T. T. T., Watanabe, K., Imamura, K., Huong, T. N., Sasaki, N., Kuribayashi, K.,
Sakuraya, A., Nga, T. N., Thu, M. B., Quynh, T. N., Tien, Q. T., Giang, T. H. N., Minas, H.,
Tsustumi, A., Shimazu, A. & Kawakami, N. (2020). Reliability and validity of the Vietnamese
version of the 9-item Utrecht Work Engagement Scale. JOURNAL OF OCCUPATIONAL
HEALTH, 62 (1), https://doi.org/10.1002/1348-9585.12157.
Persistent Link:
http://hdl.handle.net/11343/245256
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