Urdu Translation and the Validation of a 14-Item Measure to Assess Stress Management Skills in Healthcare Workers: Measurement Invariance Across Gender
Ethics in Progress (ISSN 2084-9257). Vol. 14 (2023). No. 1


Stress management skills
lifestyle healthcare workers
translation and validation

How to Cite

Ali, Y., & Farhana Kazmi, S. (2023). Urdu Translation and the Validation of a 14-Item Measure to Assess Stress Management Skills in Healthcare Workers: Measurement Invariance Across Gender. ETHICS IN PROGRESS, 14(1), 110–125. https://doi.org/10.14746/eip.2023.1.7


This study aims to conduct an Urdu translation and a validation of the ISBF Stress Management Skills Scale in two distinct phases. The first phase includes the forward-back translation method for ISBF. The second phase includes cross validation and the establishment of psychometric properties for the ISBF scale. A sample of 500 adults working in health care was taken from different hospitals and dispensaries. The first phase of the study includes the forward-back translation method. The second phase includes exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) with invariance measurement. The total reliability of the scale is reported to be .812. EFA revealed a two-factor structure for ISBF scale, with configural, metric and scalar invariance across males and females, and comparable latent mean scores for males and females. CFA showed goodness-of fit indices for the two factors. The scale showed good internal consistency values. The model fit value includes the value for the goodness of fit index, which was .979, for the adjusted goodness-of fit index: .961, for the comparative fit index: .993, for the incremental fit index: .993, and for the root mean square error of approximation (RMSEA) value: .033. Good values of composite reliability and convergent validity were measured for both dimensions of the scale. The scale shows that this diagnostic tool can help to assess the skills used to manage stress. For criterion validity, the coping Inventory for Stressful Situations (CISS-21) was used, which showed positive correlations. The subscale of stress management was taken from the Health Promoting Life Style Profile II (HPLP-II), which also showed positive correlations. Significant mean differences were found between scores of healthcare workers with stress management skills and with those without stress management skills. The group of mean differences indicated the females have greater stress management skills as compared to men. The Urdu translated and validated instrument will be helpful in understanding behavior in healthcare settings.



Aideyan B., Martin G. & Beeson M. E. 2020. “Neuroscience Informed Counselling: A Practitioners Guide to Breathwork in Clinical Mental Health Counselling,” Journal of Mental Health Counseling 42(1):78–94. DOI: https://doi.org/10.17744/mehc.42.1.06

Antoni M. et al. 2006. “How Stress Management Improves Quality of Life,” Journal of Consulting and Clinical Psychology 74(6):1143–1152. DOI: https://doi.org/10.1037/0022-006X.74.6.1143

Brislin R. W., Anderson W. & Bruce R. 1976. Translation: Applications and Research. 1st Ed. New York: Gardner Press.

Brzyski P., Kozka M., Squires A., & Brzostek T. 2016. “How Factor Analysis Results May Change Due To Country Context,” Journal of Nursing Scholarship 48(6):598–607. DOI: https://doi.org/10.1111/jnu.12249

Chi X. et al. 2018. “Effects of Mindfulness Based Stress Reduction on Depression in Young Adults,” Frontiers in Psychology 9(1):9–12. DOI: https://doi.org/10.3389/fpsyg.2018.01034

Ebner K. et al. 2018. “Coaching as Stress Management Intervention: The Mediating Role of Self Efficacy in Framework of Self Management and Coping,” International Journal of Stress Management 25(3):209. DOI: https://doi.org/10.1037/str0000058

Edwards D. & Burnard P. 2003. “A Systematic Review of Stress and Stress Management Interventions for Mental Health Nurses,” Integrative Literature Reviews and Meta-Analyses 42(2):169–200. DOI: https://doi.org/10.1046/j.1365-2648.2003.02600.x

Edwards D., Burnard P., Coyle D. et al. 2000. “Stress and Burnout in Community Mental Health Nursing: A Review of Literature,” Journal of Psychiatric and Mental Health Nursing 7(1):7–14. DOI: https://doi.org/10.1046/j.1365-2850.2000.00258.x

Endler N. & Parker J. 1992. “Coping Inventory for Stress Situations,” European Journal of Personality 6(5):321–344. DOI: https://doi.org/10.1002/per.2410060502

Fadel M., Roquelaure Y. & Descatha A. 2023. “Interventions on Well-Being, Occupational Health and Aging of Healhcare Workers-A Scoping Review of Systemic Reviews,” Safety and Health at Work 14(1):135–140. DOI: https://doi.org/10.1016/j.shaw.2022.12.003

Fenn J., Seng C. & George S. 2020. “Development, Validation and Translation of Psychological Tests,” BJPsych Advances 26(5):306–315. DOI: https://doi.org/10.1192/bja.2020.33

Fornell C. & Lacker D. 1981. “Evaluating Structural Equation Models with Unobservable Variables and Measurement Error,” Journal of Marketing Research 18(1):39–50. DOI: https://doi.org/10.1177/002224378101800104

Manning-Geist B., Meyer F., Chen J. et al. 2020. “Pre-Clinical Stress Management Workshops Increase Medical Students’ Knowledge and Self-awareness of Coping with Stress,” Medical Science Educator 30(1):235–241. DOI: https://doi.org/10.1007/s40670-019-00881-4

Gruszczynska M. et al. 2022. “The Style of Coping with Stress, the Health Related Locus of Control and Level of Mindfulness of Patients with Chronic Somatic Diseases in Comparison to Healthy People,” MDPI 10(9):1752. DOI: https://doi.org/10.3390/healthcare10091752

Gupta A., Mehra A. & Niraula A. 2020. “Prevalence of Anxiety and Depression Among the Healthcare Workers in Nepal During Covid-19,” Asian Journal of Psychiatry 1(2):54. DOI: https://doi.org/10.1016/j.ajp.2020.102260

Hair J. et al. 2006. Multivariate Data Analysis. 6th Ed. Upper Saddle River: Pearson.

Hammerfald K., Eberle C., Grau M. & Kinsperger A. 2006. “Persistent Effects of Cognitive Behavioral Stress Management on Cortisol Responses to Acute Stress in Health Subjects,” Psychoneuroendocrinology 31(3):333–339. DOI: https://doi.org/10.1016/j.psyneuen.2005.08.007

Hersch R., Cook R. & Deitz 2016. “Reducing Nurses’ Stress- A Randomized Controlled Trial of a Web-Based Stress Management Progrm for Nurses,” Applied Nursing Research 32(1):18–25. DOI: https://doi.org/10.1016/j.apnr.2016.04.003

Hu L. & Bentler P. 1999. “Cutoff Criteria for Fit Indexes in Covariance Structure Analysis: Conventional Criteria Verses New Alternatives,” Structural Equation Modelling 6(1):1–55. DOI: https://doi.org/10.1080/10705519909540118

Kälin W. 1995. Deutsche 24-Item Kurzform des ‚Coping Inventory for Stressful Situations‘ (CISS) von NS Endler & JDA Parker. Bern: Universität Bern.

Lai J., Ma S. & Wang Y. 2020. “Factors Associated with Mental Health Outcomes Among Healthcare Workers Exposed to Coronavirus Diseases,” JAMA Network Open 3(3):203–206. DOI: https://doi.org/10.1001/jamanetworkopen.2020.3976

Marques R., Mello C. R., Silva M. A. & Oliveira A. S. D. 2014. “Performance of the Probabilty Distribtion Models Applied to Heavy Rainfall Daily Events,” Ciencia e Agrotecnologia 38(4):335–342. DOI: https://doi.org/10.1590/S1413-70542014000400003

Pocnet C. et al. 2015. “Influence of Individual Characteristics on Work Engagement and Job Stress in a Sample of National and Foreign Workers in Switzerland,” Swiss Journal of Psychology 74(1):17. DOI: https://doi.org/10.1024/1421-0185/a000146

Rahe R., Richard H. & Robbyn L. 2002. “The Brief Stress and Coping Inventory: A Useful Stress Mangaement Instrument,” International Journal of Stress Management 9:61–70. DOI: https://doi.org/10.1023/A:1014950618756

Rai A., Suzen H. & Pavi M. 2021. “Exploration of Perceived Stresss Among Married and Unmarried Women Employees in Public and Private Sector,” InternationalJjournal of All Research and Scientific Methods 9(10):429–431.

Shahid H., Abul Hasan M., Ejaz O. et al. 2022. “The Severity of Depression, Anxiety and Stress: Recommendations from Joint Work of Research Center and Psychology Clinics in COVID-19 Pandemic,” Frontiers in Psychiatry 13:839542. DOI: https://doi.org/10.3389/fpsyt.2022.839542

Vandenberg R. J. & Lance C. E. 2000. “A Review and Synthesis of the Measurement Invariance Literature: Suggestions, Practices, and Recommendations for Organizational Research,” Organizational Research Methods 3(1):4–70. DOI: https://doi.org/10.1177/109442810031002

Walker S. N., Volkan K., Sechrist K. R., & Pender N. J. 1988. “Health-Promoting Lifestyles of Older Adults: Comparisons with Young and Middle-Aged Adults, Correlates and Patterns,” Advances in Nursing Science 11(1):76–90. DOI: https://doi.org/10.1097/00012272-198810000-00008

Wirtz P. 2012. “Inventory for Assessment of Stress Management Skills (ISBF): Psychometric and Endocrine Validation of Questionnaire to Determine Perceived Stress Management Skills,” Psychoneuroendocrinology 38(4):572–856. DOI: https://doi.org/10.1016/j.psyneuen.2012.07.017

Yáñez J.A., Afshar Jahanshahi A., Alvarez-Risco A. et al. 2020. “Anxiety, Distress, and Turnover Intention of Healthcare Workers in Peru by Their Distance to the Epicenter during the COVID-19 Crisis,” American Journal of Tropical Medicine and Hygiene 103(4):1614–1620. DOI: https://doi.org/10.4269/ajtmh.20-0800